# CARRIE L. CHASTAIN D.D.S. PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275861726
- **Authorized official:** PAULA BOLER (OFFICE MANAGER)
- **Authorized official phone:** (580) 233-2044

## Contact information

- **Practice address:** 702 E PARK ST, ENID, OK 73701-5930
- **Practice address phone:** (580) 233-2044
- **Mailing address:** 702 E PARK ST, ENID, OK 73701-5930
- **Mailing address phone:** (580) 233-2044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5781 | OK | Yes |

## Other

- **Enumeration date:** 11/20/2009
- **Last updated:** 11/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200064070A | — | OK |