Provider Demographics
NPI:1528302171
Name:CHAPMAN, KEITH EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:EDWARD
Last Name:CHAPMAN
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 1:1754 S RUTHERFORD BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-0721
Mailing Address - Country:US
Mailing Address - Phone:615-849-1292
Mailing Address - Fax:615-849-1293
Practice Address - Street 1:1754 S RUTHERFORD BLVD
Practice Address - Street 2:STE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-0721
Practice Address - Country:US
Practice Address - Phone:615-849-1292
Practice Address - Fax:615-849-1293
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist