MEDICARE: CHANDLER DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1760236327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDLER DENTAL PLLC

Provider Business Mailing Address
First Line	:	851 W I 35 FRONTAGE RD STE 350
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-7461
Country	:	US
Telephone Number	:	405-930-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 E 1ST ST STE A
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-2422
Country	:	US
Telephone Number	:	405-328-7602
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BENJAMIN BOWMAN
Credential	:	DDS
Telephone Number	:	405-326-8004

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	08/29/2024

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