Provider Demographics
NPI:1487077855
Name:J. CARL CHILTON DDS, INC
Entity type:Organization
Organization Name:J. CARL CHILTON DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-274-5329
Mailing Address - Street 1:434 WEATHERLY ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4220
Mailing Address - Country:US
Mailing Address - Phone:806-274-5329
Mailing Address - Fax:806-274-7115
Practice Address - Street 1:434 WEATHERLY ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4220
Practice Address - Country:US
Practice Address - Phone:806-274-5329
Practice Address - Fax:806-274-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1995029-01Medicaid