Provider Demographics
NPI:1164560900
Name:CHENOVICK, DENNIS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:CHENOVICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 HELENA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3558
Mailing Address - Country:US
Mailing Address - Phone:406-442-5930
Mailing Address - Fax:406-442-5931
Practice Address - Street 1:1093 HELENA AVENUE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3558
Practice Address - Country:US
Practice Address - Phone:406-442-5930
Practice Address - Fax:406-442-5931
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0117403Medicaid