MEDICARE: MRS. JENNIFER S. CHADWELL D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7004	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194095398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER S. CHADWELL D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 687
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-0687
Country	:	US
Telephone Number	:	606-256-5812
Fax Number	:	606-256-3748

Provider Business Practice Location Address
First Line	:	325 RICHMOND STREET
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2712
Country	:	US
Telephone Number	:	606-256-5812
Fax Number	:	606-256-3748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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