Provider Demographics
NPI:1548298342
Name:CHILES, DONALD GLENN (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:GLENN
Last Name:CHILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DOS CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3980
Mailing Address - Country:US
Mailing Address - Phone:907-868-3848
Mailing Address - Fax:907-729-2954
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:DENTAL DEPT.-ALASKA NATIVE MEDICAL CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2049
Practice Address - Fax:907-729-2054
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery