Healthcare Provider Details

I. General information

NPI: 1003102807
Provider Name (Legal Business Name): NATHAN E. CHANDLER D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 E 9400 S STE 101
SANDY UT
84094-3693
US

IV. Provider business mailing address

870 E 9400 S STE 101
SANDY UT
84094-3693
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-3446
  • Fax: 801-571-1340
Mailing address:
  • Phone: 801-571-3446
  • Fax: 801-571-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5386766
License Number StateUT

VIII. Authorized Official

Name: DR. NATHAN ERIC CHANDLER
Title or Position: OWNER
Credential: DDS
Phone: 801-571-3446