Healthcare Provider Details

I. General information

NPI: 1730198409
Provider Name (Legal Business Name): STACY ANN CHANDLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 WEST MAIN ST
MONONGAHELA PA
15063
US

IV. Provider business mailing address

2121 GIBSONTON RD
BELLE VERNON PA
15012
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-4440
  • Fax: 724-258-6454
Mailing address:
  • Phone: 724-244-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH067857
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: