Healthcare Provider Details

I. General information

NPI: 1508880923
Provider Name (Legal Business Name): KENNETH W CHAPMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W HARPER ST
RICHLAND MS
39218-9424
US

IV. Provider business mailing address

120 W HARPER ST
RICHLAND MS
39218-9424
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-9502
  • Fax:
Mailing address:
  • Phone: 601-939-9502
  • Fax: 601-939-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1882-80
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: