Healthcare Provider Details

I. General information

NPI: 1073444717
Provider Name (Legal Business Name): CAMDEN REID CHASTAIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 SW 3RD ST STE M
LEES SUMMIT MO
64063-2280
US

IV. Provider business mailing address

20712 W 58TH ST
SHAWNEE KS
66218-9234
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-3535
  • Fax:
Mailing address:
  • Phone: 913-957-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026022872
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: