MEDICARE: CLAY STEVEN CHANDLER DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5469	LA

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	:	1801068978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAY STEVEN CHANDLER DDS, MD

Provider Business Mailing Address
First Line	:	3839 W CONGRESS ST STE C
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-6000
Country	:	US
Telephone Number	:	337-984-0403
Fax Number	:	337-981-9006

Provider Business Practice Location Address
First Line	:	3839 W CONGRESS ST STE C
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-6000
Country	:	US
Telephone Number	:	337-984-0403
Fax Number	:	337-981-9006

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

Provider Enumeration Date	:	03/29/2008
Last Update Date	:	06/24/2016

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