Provider Demographics
NPI:1073814810
Name:LEE C. CHEWNING DMD PC
Entity Type:Organization
Organization Name:LEE C. CHEWNING DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:CAIN
Authorized Official - Last Name:CHEWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-774-6500
Mailing Address - Street 1:191 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2217
Mailing Address - Country:US
Mailing Address - Phone:724-774-6500
Mailing Address - Fax:724-774-6962
Practice Address - Street 1:191 S PARK ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2217
Practice Address - Country:US
Practice Address - Phone:724-774-6500
Practice Address - Fax:724-774-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022859L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty