MEDICARE: THOMAS CHANDLER

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	21656	TX

General Provider Information

NPI Number	:	1215152228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS CHANDLER

Provider Business Mailing Address
First Line	:	9200 WHITE SETTLEMENT RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-2028
Country	:	US
Telephone Number	:	817-246-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 WHITE SETTLEMENT RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-2028
Country	:	US
Telephone Number	:	817-246-2721
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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Directions to “ THOMAS CHANDLER ” Practice Location

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