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General NPI Number Information
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NPI Number | 1245648724
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Entity Type | Individual
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Provider Name | JORDON CHANDLER DMD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 2341 W MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-7007
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Country | US
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Telephone | 706-245-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 2341 W MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-7007
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Country | US
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Telephone | 706-245-5031
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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 | DN014828
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License Number State | GA
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