Healthcare Provider Details

I. General information

NPI: 1508158858
Provider Name (Legal Business Name): HEATHER ELIZABETH CHANCE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MONROE AVE STE 30
ROCHESTER NY
14618-4725
US

IV. Provider business mailing address

3400 MONROE AVE STE 30
ROCHESTER NY
14618-4725
US

V. Phone/Fax

Practice location:
  • Phone: 585-643-8310
  • Fax: 585-643-8311
Mailing address:
  • Phone: 585-643-8310
  • Fax: 585-643-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number058825-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: