Healthcare Provider Details

I. General information

NPI: 1801109434
Provider Name (Legal Business Name): BRIAN CHANDLER OTT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2010
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 WORTH PARK
CHARLOTTESVILLE VA
22911-7441
US

IV. Provider business mailing address

1751 WINTERBERRY CT
CHARLOTTESVILLE VA
22911-8249
US

V. Phone/Fax

Practice location:
  • Phone: 434-964-0088
  • Fax:
Mailing address:
  • Phone: 434-202-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: