Healthcare Provider Details

I. General information

NPI: 1013064864
Provider Name (Legal Business Name): JEFFREY W CHANDLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD SUITE 220
ELMHURST IL
60126-5068
US

IV. Provider business mailing address

360 W BUTTERFIELD RD SUITE 220
ELMHURST IL
60126-5068
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-0395
  • Fax: 630-833-0399
Mailing address:
  • Phone: 630-833-0395
  • Fax: 630-833-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number036158773
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019026314
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: