Provider Demographics
NPI:1215022413
Name:CHESTER, TONY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:A
Last Name:CHESTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 478
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0009
Mailing Address - Country:US
Mailing Address - Phone:706-265-6877
Mailing Address - Fax:706-265-7932
Practice Address - Street 1:638 HIGHWAY 9 NORTH
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0009
Practice Address - Country:US
Practice Address - Phone:706-265-6877
Practice Address - Fax:706-265-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice