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General NPI Number Information
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NPI Number | 1639855547
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Entity Type | Individual
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Provider Name | CHANDLER TEMPEST DMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 5745 W. BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634
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Country | US
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Telephone | 773-312-7569
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Fax |
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Provider Business Mailing Address
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Address Line | 1395 CRAB POINT ROAD
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City | WHITE STONE
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State | VA
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Zip | 22578
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Country | US
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Telephone | 847-612-1745
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.034403
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License Number State | IL
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