Provider Demographics
NPI:1992733174
Name:CHANEY, PATRICK ALLAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ALLAN
Last Name:CHANEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W HIGH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3971
Mailing Address - Country:US
Mailing Address - Phone:419-227-5155
Mailing Address - Fax:419-227-4370
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-227-5155
Practice Address - Fax:419-227-4370
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300176351223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704689Medicaid
OHCHO652953Medicare ID - Type Unspecified