Healthcare Provider Details

I. General information

NPI: 1497497945
Provider Name (Legal Business Name): CHKDG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 W COUNTRY CLUB RD
CHICKASHA OK
73018-7281
US

IV. Provider business mailing address

839 W COUNTRY CLUB RD
CHICKASHA OK
73018-7281
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-7036
  • Fax:
Mailing address:
  • Phone: 405-224-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA BRASHER
Title or Position: PRESIDENT
Credential: DDS
Phone: 405-474-6362