Provider Demographics
NPI:1003961442
Name:EVERETT, CHANTEL C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:C
Last Name:EVERETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HIGHWAY 80 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4748
Mailing Address - Country:US
Mailing Address - Phone:601-925-4727
Mailing Address - Fax:601-925-4753
Practice Address - Street 1:380 HIGHWAY 80 E
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4748
Practice Address - Country:US
Practice Address - Phone:601-925-4727
Practice Address - Fax:601-925-4753
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2821-941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice