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General NPI Number Information
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NPI Number | 1013480565
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Entity Type | Individual
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Provider Name | CHANDLER ASHLEE GOLTZ DMD
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 110 VILLAGE ST
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City | SLIDELL
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State | LA
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Zip | 70458-5300
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Country | US
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Telephone | 985-643-7516
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Fax | 985-646-2503
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Provider Business Mailing Address
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Address Line | 110 VILLAGE ST
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City | SLIDELL
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State | LA
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Zip | 70458-5300
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Country | US
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Telephone | 985-643-7516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0006587-C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7164
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License Number State | LA
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