MEDICARE: DR. CHANDLER TEMPEST DMD

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	019.034403	IL

General Provider Information

NPI Number	:	1639855547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDLER TEMPEST DMD

Provider Business Mailing Address
First Line	:	1395 CRAB POINT ROAD
Second Line	:
City	:	WHITE STONE
State	:	VA
Zip	:	22578
Country	:	US
Telephone Number	:	847-612-1745
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 W. BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634
Country	:	US
Telephone Number	:	773-312-7569
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	09/18/2023

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