Individual
BLAKE CHANDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7409 ALCOA RD STE 5, BRYANT, AR 72022-6216
(602) 430-0106
Mailing address
4004 STONEYBROOK DR, BRYANT, AR 72022-8300
(602) 430-0106
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
30776
TX
1223P0221X
Pediatric Dentistry
Primary
4002
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235188012
—
AR
05
—
721359
—
AZ
Enumeration date
05/09/2006
Last updated
03/27/2016
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