Provider Demographics
NPI:1972547958
Name:CHASE, CAROLYN COWEN (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:COWEN
Last Name:CHASE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FIRE ROAD 268
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03884-6722
Mailing Address - Country:US
Mailing Address - Phone:603-664-1503
Mailing Address - Fax:603-436-0019
Practice Address - Street 1:1000 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4224
Practice Address - Country:US
Practice Address - Phone:603-436-8030
Practice Address - Fax:603-436-0019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist