1225235807 NPI number — CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC

Table of content: DR. PRAMOD KUMAR SRIVASTAVA MD (NPI 1134226335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225235807 NPI number — CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225235807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STARLING LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-984-0403
Provider Business Mailing Address Fax Number:
337-981-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STARLING LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-984-0403
Provider Business Practice Location Address Fax Number:
337-981-9006
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FABRE
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
337-984-0403

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  2529 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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