Healthcare Provider Details

I. General information

NPI: 1518694934
Provider Name (Legal Business Name): CHANDLER BRENNAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 N UNION BLVD STE 101
COLORADO SPRINGS CO
80920-4081
US

IV. Provider business mailing address

822 OLD DUTCH MILL RD
COLORADO SPRINGS CO
80907-3870
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-1293
  • Fax:
Mailing address:
  • Phone: 920-901-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00205303
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: