Provider Demographics
NPI:1063622553
Name:CHASE, HARRY MCCLURE (DDS)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:MCCLURE
Last Name:CHASE
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 1:2018 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5203
Mailing Address - Country:US
Mailing Address - Phone:770-934-2728
Mailing Address - Fax:770-934-1127
Practice Address - Street 1:2018 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5203
Practice Address - Country:US
Practice Address - Phone:770-934-2728
Practice Address - Fax:770-934-1127
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0113891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice