Provider Demographics
NPI:1154754356
Name:CHANCE, KARI LYN (RDH, BS)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9246 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-6373
Mailing Address - Country:US
Mailing Address - Phone:715-831-0737
Mailing Address - Fax:
Practice Address - Street 1:9246 24TH AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-6373
Practice Address - Country:US
Practice Address - Phone:715-831-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10184-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist