Healthcare Provider Details

I. General information

NPI: 1861571309
Provider Name (Legal Business Name): CHESTER ARTHUR RYCROFT III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N MAIN ST
EVANSVILLE IN
47711-5026
US

IV. Provider business mailing address

1120 N MAIN ST
EVANSVILLE IN
47711-5026
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-3113
  • Fax: 812-424-3113
Mailing address:
  • Phone: 812-424-3113
  • Fax: 812-424-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7115
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: