Provider Demographics
NPI:1487153557
Name:CHELSEA ORTHODONTICS
Entity type:Organization
Organization Name:CHELSEA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-678-2770
Mailing Address - Street 1:300 JADE PARK STE 301
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8349
Mailing Address - Country:US
Mailing Address - Phone:205-678-2770
Mailing Address - Fax:205-678-2775
Practice Address - Street 1:300 JADE PARK STE 301
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8349
Practice Address - Country:US
Practice Address - Phone:205-678-2770
Practice Address - Fax:205-678-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty