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General NPI Number Information
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NPI Number | 1215030804
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Entity Type | Organization
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Legal Business Name | DRS CHAPMAN & CONNELLY DDS SC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 RIVERSIDE DRIVE
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City | BELOIT
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State | WI
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Zip | 53511-2932
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Country | US
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Telephone | 608-365-4006
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Fax | 608-365-4870
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Provider Business Mailing Address
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Address Line | 2101 RIVERSIDE DRIVE
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City | BELOIT
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State | WI
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Zip | 53511-2932
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Country | US
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Telephone | 608-365-4006
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Fax | 608-365-4870
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY F CHAPMAN
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Credential | DDS
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Telephone | 608-365-4006
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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 | 5002032015
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License Number State | WI
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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 | 5002049015
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License Number State | WI
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