Provider Demographics
NPI:1316274509
Name:DR DON M CHANEY DDS PA
Entity type:Organization
Organization Name:DR DON M CHANEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-442-3144
Mailing Address - Street 1:2801 MAIN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5264
Mailing Address - Country:US
Mailing Address - Phone:479-442-3144
Mailing Address - Fax:479-442-3757
Practice Address - Street 1:2801 MAIN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5264
Practice Address - Country:US
Practice Address - Phone:479-442-3144
Practice Address - Fax:479-442-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X467OtherAR BCBS
AR1416770OtherUNITED CONCORDIA
AR177184631Medicaid