Provider Demographics
NPI: | 1699297366 |
---|---|
Name: | CHESNEY DENTISTRY |
Entity type: | Organization |
Organization Name: | CHESNEY DENTISTRY |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERESA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOSTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 865-966-7441 |
Mailing Address - Street 1: | 111 LOUDOUN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | KNOXVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37934-2942 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-966-7441 |
Mailing Address - Fax: | 865-966-4011 |
Practice Address - Street 1: | 111 LOUDOUN RD |
Practice Address - Street 2: | |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37934-2942 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-966-7441 |
Practice Address - Fax: | 865-966-4011 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | GARY CHESNEY, DDS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-07-13 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | DS4180 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |