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General NPI Number Information
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NPI Number | 1558524561
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Entity Type | Individual
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Provider Name | EVAN C. CHALK DMD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1922 THOMSON DR
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City | LYNCHBURG
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State | VA
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Zip | 24501-1019
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Country | US
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Telephone | 434-845-1121
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Fax | 434-845-1096
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Provider Business Mailing Address
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Address Line | 1922 THOMSON DR
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City | LYNCHBURG
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State | VA
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Zip | 24501-1019
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Country | US
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Telephone | 434-845-1121
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Fax | 434-845-1096
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0438000335
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 0438000335
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License Number State | VA
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