Provider Demographics
NPI:1306153796
Name:PRETTYMAN, CHASE T (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:T
Last Name:PRETTYMAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:202 E WOODLAWN RD
Mailing Address - Street 2:STE 114
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2213
Mailing Address - Country:US
Mailing Address - Phone:704-522-1550
Mailing Address - Fax:704-522-1558
Practice Address - Street 1:202 E WOODLAWN RD
Practice Address - Street 2:STE 144A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2213
Practice Address - Country:US
Practice Address - Phone:704-247-9150
Practice Address - Fax:704-529-1420
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915841Medicaid