Healthcare Provider Details

I. General information

NPI: 1144775305
Provider Name (Legal Business Name): CHADWICK AUGUSTY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MAIN ST STE 3
DOWNERS GROVE IL
60516-3495
US

IV. Provider business mailing address

1114 W CARROLL AVE APT 407
CHICAGO IL
60607-3253
US

V. Phone/Fax

Practice location:
  • Phone: 630-633-3092
  • Fax:
Mailing address:
  • Phone: 615-390-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10345
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.003529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: