Basic Information
| Provider Information | |||||||||
| NPI: | 1366818965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALBOT | ||||||||
| FirstName: | CHASE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | BUILDING 2238, BOX #555221 | ||||||||
| Address2: | 1ST DENTAL BATTALION | ||||||||
| City: | CAMP PENDLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920555221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607255419 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BUILDING 2238, BOX #555221 | ||||||||
| Address2: | 1ST DENTAL BATTALION/ NAVAL DENTAL CENTER | ||||||||
| City: | CAMP PENDLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920555221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607255419 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60576287 | WA | Y | Dental Providers | Dentist |
No ID Information.