Provider Demographics
NPI:1023261641
Name:LEONARD M CHANCE
Entity type:Organization
Organization Name:LEONARD M CHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:360-452-9744
Mailing Address - Street 1:104 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2825
Mailing Address - Country:US
Mailing Address - Phone:360-452-9744
Mailing Address - Fax:360-452-5861
Practice Address - Street 1:104 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2825
Practice Address - Country:US
Practice Address - Phone:360-452-9744
Practice Address - Fax:360-452-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50200-03Medicaid