Provider Demographics
NPI:1427305580
Name:NOSEK, CHAD BARRETT (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:BARRETT
Last Name:NOSEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 E PARIS AVE SE STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3682
Mailing Address - Country:US
Mailing Address - Phone:978-618-3440
Mailing Address - Fax:
Practice Address - Street 1:27949 GREENSPOT RD
Practice Address - Street 2:SUITE H
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-4443
Practice Address - Country:US
Practice Address - Phone:909-864-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616691223G0001X
MI29016009161223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No1223G0001XDental ProvidersDentistGeneral Practice