MEDICARE: DOUGLAS C.CHANCELLOR D.D.S.P.C.

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	261Q00000X	Clinic/Center	4404	OK

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	:	1467639146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS C.CHANCELLOR D.D.S.P.C.

Provider Business Mailing Address
First Line	:	2603 PAWNEE XING
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6882
Country	:	US
Telephone Number	:	405-348-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 NW EXPRESSWAY
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1533
Country	:	US
Telephone Number	:	405-848-4442
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DOUGLAS C CHANCELLOR
Credential	:	D.D.S.
Telephone Number	:	405-348-5254

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	03/28/2013

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