Eugene Chickinell, DDS
Individual provider Active NPI Dentist · Brookings, OR
NPI 1003236134 · NPPES record last updated Apr 16, 2014
Key facts
- NPI
- 1003236134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D4605 (OR)
- Practice address
- 548 Pacific Ave
Brookings, OR 97415-8982 - Phone
- (541) 469-4995
- Fax
- (541) 469-4408
- NPI assigned
- Apr 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4605 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gene Chickinell DDS PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D4605 | OR | Yes |
Addresses
Primary practice location
548 Pacific Ave
Brookings, OR 97415-8982
Mailing address
PO Box 8160
Brookings, OR 97415-0381
Phone (541) 469-4995
Other providers in Brookings, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.