Provider Demographics
NPI:1043637093
Name:CHIASSON, ASTRID
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:CHIASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASTRID
Other - Middle Name:
Other - Last Name:CHIASSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LD
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-0549
Mailing Address - Country:US
Mailing Address - Phone:207-642-2310
Mailing Address - Fax:207-642-6815
Practice Address - Street 1:178 CAPE RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6147
Practice Address - Country:US
Practice Address - Phone:207-642-2310
Practice Address - Fax:207-642-6815
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5051122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist