Provider Demographics
NPI:1063562460
Name:CHATTANOOGA PERIODONTICS & DENTAL IMPLANTS, PC
Entity type:Organization
Organization Name:CHATTANOOGA PERIODONTICS & DENTAL IMPLANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:423-756-2450
Mailing Address - Street 1:951 RIVERFRONT PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2185
Mailing Address - Country:US
Mailing Address - Phone:423-756-2450
Mailing Address - Fax:423-756-5451
Practice Address - Street 1:951 RIVERFRONT PKWY
Practice Address - Street 2:STE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2185
Practice Address - Country:US
Practice Address - Phone:423-756-2450
Practice Address - Fax:423-756-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS94621223P0300X
TNDS31071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty