Healthcare Provider Details

I. General information

NPI: 1891733622
Provider Name (Legal Business Name): JOHN NICHOLAS CHIAPEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOHN NICHOLAS CHIAPEL D.D.S.

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16921 MANCHESTER RD
WILDWOOD MO
63040-1209
US

IV. Provider business mailing address

16921 MANCHESTER RD
WILDWOOD MO
63040-1209
US

V. Phone/Fax

Practice location:
  • Phone: 636-405-1400
  • Fax: 636-405-1412
Mailing address:
  • Phone: 636-405-1400
  • Fax: 636-405-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE 15662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: