=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891393427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS A CHADWICK DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2020
-----------------------------------------------------
Last Update Date | 10/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 SE DOUGLAS ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-4426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-265-4221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 334 NW HIGH ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-689-2046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DENTIST
-----------------------------------------------------
Name | DR. DOUG A CHADWICK
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 541-265-4221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------