Healthcare Provider Details

I. General information

NPI: 1982825378
Provider Name (Legal Business Name): JOEL B CHASEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/12/2020
Certification Date: 04/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S BROAD ST SUITE 3B
MERIDEN CT
06450-6600
US

IV. Provider business mailing address

546 S BROAD ST SUITE 3B
MERIDEN CT
06450-6600
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-7449
  • Fax: 203-237-1234
Mailing address:
  • Phone: 203-237-7449
  • Fax: 203-237-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number009031
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: