Provider Demographics
NPI:1235681552
Name:WALTER C. CHITWOOD JR. DDS, PC
Entity Type:Organization
Organization Name:WALTER C. CHITWOOD JR. DDS, PC
Other - Org Name:IMPLANT AND GENERAL DENTISTRY OF MIDDLE TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-893-8771
Mailing Address - Street 1:1110 W CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2340
Mailing Address - Country:US
Mailing Address - Phone:615-893-8771
Mailing Address - Fax:615-893-8781
Practice Address - Street 1:1110 W CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2340
Practice Address - Country:US
Practice Address - Phone:615-893-8771
Practice Address - Fax:615-893-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1679691992OtherNPI
TN1457729774OtherNPI