Provider Demographics
NPI:1851411649
Name:CHANCE, JEREMY WADE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WADE
Last Name:CHANCE
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 1:2511 W HOLCOMBE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1903
Mailing Address - Country:US
Mailing Address - Phone:713-666-0003
Mailing Address - Fax:713-666-7999
Practice Address - Street 1:2511 W HOLCOMBE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1903
Practice Address - Country:US
Practice Address - Phone:713-666-0003
Practice Address - Fax:713-666-7999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice