Provider Demographics
NPI:1992581672
Name:SMITH, CHANDLER DIANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:DIANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 LAKE HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2946
Mailing Address - Country:US
Mailing Address - Phone:254-749-7972
Mailing Address - Fax:
Practice Address - Street 1:1701 LAKE SUCCESS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2964
Practice Address - Country:US
Practice Address - Phone:254-772-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice