Basic Information
| Provider Information | |||||||||
| NPI: | 1811050842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENMAN | ||||||||
| FirstName: | CHADWICK | ||||||||
| MiddleName: | RHETT | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3617 JORGE DR APT D | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128328448 | ||||||||
| FaxNumber: | 5128328454 | ||||||||
| Practice Location | |||||||||
| Address1: | 8522 N LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787535543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128328448 | ||||||||
| FaxNumber: | 5128328454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 22794 | TX | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 181183801 | 05 | TX | MEDICAID |