Provider Demographics
NPI:1588874416
Name:CHANEY, MICHAEL ALFRED (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALFRED
Last Name:CHANEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:131 N. ROSINA AVE.
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-0354
Mailing Address - Country:US
Mailing Address - Phone:814-443-1481
Mailing Address - Fax:814-443-4233
Practice Address - Street 1:131 N ROSINA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1505
Practice Address - Country:US
Practice Address - Phone:814-443-1481
Practice Address - Fax:814-443-4233
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024602-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics