Provider Demographics
NPI:1578355111
Name:HARNAGE, CHANDLER (DMD)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:HARNAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 TAPESTRY CIR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-8310
Mailing Address - Country:US
Mailing Address - Phone:270-282-3193
Mailing Address - Fax:
Practice Address - Street 1:710 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4504
Practice Address - Country:US
Practice Address - Phone:502-363-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY113291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice