Organization
CARRIE L. CHASTAIN D.D.S. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA BOLER (OFFICE MANAGER)
(580) 233-2044
Entity
Organization
Contact information
Practice address
702 E PARK ST, ENID, OK 73701-5930
(580) 233-2044
Mailing address
702 E PARK ST, ENID, OK 73701-5930
(580) 233-2044
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5781
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200064070A
—
OK
Enumeration date
11/20/2009
Last updated
11/20/2009
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