Provider Demographics
NPI:1194391995
Name:CHAUNCEY, ROBERT TATE (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TATE
Last Name:CHAUNCEY
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 BRIGHTON HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0527
Mailing Address - Country:US
Mailing Address - Phone:702-306-1830
Mailing Address - Fax:
Practice Address - Street 1:1465 E LAKE MEAD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-4631
Practice Address - Country:US
Practice Address - Phone:702-330-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-3691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics