Healthcare Provider Details

I. General information

NPI: 1588634877
Provider Name (Legal Business Name): J. FREDERICK CHAIRSELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GOOD DR
LANCASTER PA
17603-2353
US

IV. Provider business mailing address

190 GOOD DR
LANCASTER PA
17603-2353
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3033
  • Fax: 717-390-2641
Mailing address:
  • Phone: 717-394-3033
  • Fax: 717-390-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS018475L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS018475L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: