Provider Demographics
NPI:1104654821
Name:FLOWERS, CHAUNCEY L
Entity type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:L
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 E 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-8001
Mailing Address - Country:US
Mailing Address - Phone:813-510-0471
Mailing Address - Fax:
Practice Address - Street 1:36000 SHOEMAKER LANE
Practice Address - Street 2:SUITE 1051
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:813-510-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist