Provider Demographics
NPI:1316737315
Name:HARBIN, CHANDLER LEE (DMD STUDENT)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:LEE
Last Name:HARBIN
Suffix:
Gender:M
Credentials:DMD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 LIBERTY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1107
Mailing Address - Country:US
Mailing Address - Phone:479-616-2778
Mailing Address - Fax:
Practice Address - Street 1:1802 NW 52ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3122
Practice Address - Country:US
Practice Address - Phone:580-248-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program