Provider Demographics
NPI:1043339427
Name:MCCHESNEY, DAVID JAMES
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:MCCHESNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1715
Mailing Address - Country:US
Mailing Address - Phone:248-674-4659
Mailing Address - Fax:248-674-2087
Practice Address - Street 1:5155 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1715
Practice Address - Country:US
Practice Address - Phone:248-674-4659
Practice Address - Fax:248-674-2087
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI100041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice