Provider Demographics
NPI:1235799230
Name:MENEELY, CHET (DDS)
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:MENEELY
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 1:402 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1250
Mailing Address - Country:US
Mailing Address - Phone:712-243-3275
Mailing Address - Fax:
Practice Address - Street 1:402 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1250
Practice Address - Country:US
Practice Address - Phone:712-243-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA96681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice