Healthcare Provider Details

I. General information

NPI: 1720113194
Provider Name (Legal Business Name): PAUL D CHIZMAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ROCK SPRINGS RD
CONOWINGO MD
21918-1352
US

IV. Provider business mailing address

PO BOX 99
CONOWINGO MD
21918-0099
US

V. Phone/Fax

Practice location:
  • Phone: 410-378-9696
  • Fax: 410-378-0787
Mailing address:
  • Phone: 410-378-9696
  • Fax: 410-378-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7231
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: