Provider Demographics
NPI:1225235807
Name:CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC
Entity type:Organization
Organization Name:CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:FABRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-984-0403
Mailing Address - Street 1:300 STARLING LANE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-984-0403
Mailing Address - Fax:337-981-9006
Practice Address - Street 1:300 STARLING LANE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-984-0403
Practice Address - Fax:337-981-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25291223S0112X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU34680Medicare UPIN
LAT19758Medicare UPIN