Provider Demographics
NPI:1053481341
Name:CHRISMAN, DAVID NOYCE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NOYCE
Last Name:CHRISMAN
Suffix:JR
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 1:1954 VIA CTR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6056
Mailing Address - Country:US
Mailing Address - Phone:760-726-0054
Mailing Address - Fax:760-726-5375
Practice Address - Street 1:1954 VIA CTR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6056
Practice Address - Country:US
Practice Address - Phone:760-726-0054
Practice Address - Fax:760-726-5375
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174949820Medicare NSC