Provider Demographics
NPI:1093873275
Name:CHANDLER, ROBERT GAITLEY (DDS MS PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GAITLEY
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17265
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-7265
Mailing Address - Country:US
Mailing Address - Phone:919-786-4470
Mailing Address - Fax:919-786-4471
Practice Address - Street 1:4601 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 1A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-786-4470
Practice Address - Fax:919-786-4471
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4041122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics