Provider Demographics
NPI:1225078470
Name:MCDONALD, CHAUNCEY MAURICE (DDS)
Entity Type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:MAURICE
Last Name:MCDONALD
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 1:800 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6412
Mailing Address - Country:US
Mailing Address - Phone:910-738-4770
Mailing Address - Fax:910-737-6567
Practice Address - Street 1:800 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6412
Practice Address - Country:US
Practice Address - Phone:910-738-4770
Practice Address - Fax:910-737-6567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141EXOtherBCBS OF NC
NC8995690Medicaid
NC8995690Medicaid