=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548282387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAPMAN & OWENS DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 WESTBROOK PLAZA DR STE 201
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-765-8878
-----------------------------------------------------
Fax | 336-765-4480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 WESTBROOK PLAZA DR STE 201
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-765-8878
-----------------------------------------------------
Fax | 336-765-4480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER MANAGER
-----------------------------------------------------
Name | DR. KENNETH ETHERIDGE CHAPMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 336-765-8878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------