Provider Demographics
NPI:1114925625
Name:CHAFIN, TERI DIANNE (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:DIANNE
Last Name:CHAFIN
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:DENTAL HEALTH SERVICES
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1422
Mailing Address - Fax:205-930-1448
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:DENTAL HEALTH SERVICES
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-930-1422
Practice Address - Fax:205-930-1448
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO 47711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519839CHAOtherBC/BS OF ALABAMA
AL009934455Medicaid
AL009941385Medicaid
AL51519941CHAOtherBC/BS OF ALABAMA
AL51513226CHAOtherBC/BS OF ALABAMA
AL009941395Medicaid
AL009941405Medicaid
AL51519943CHAOtherBC/BS OF ALABAMA
AL009941405Medicaid