Healthcare Provider Details

I. General information

NPI: 1023303674
Provider Name (Legal Business Name): JOHN CHASE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 22ND AVE NW
MINOT ND
58703-0986
US

IV. Provider business mailing address

600 22ND AVE NW
MINOT ND
58703-0986
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-0632
  • Fax: 701-852-0468
Mailing address:
  • Phone: 701-852-0632
  • Fax: 701-852-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2103
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: