Provider Demographics
NPI:1659264067
Name:CHADWICK, EVAN REESE (DMD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:REESE
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7830
Mailing Address - Country:US
Mailing Address - Phone:270-300-9684
Mailing Address - Fax:
Practice Address - Street 1:1602 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5458
Practice Address - Country:US
Practice Address - Phone:270-491-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY113741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice