Provider Demographics
NPI:1235814153
Name:MARK S CHANEY DMD AND NICHOLAS CHANEY DDS (NORTHSHORE) LLC
Entity Type:Organization
Organization Name:MARK S CHANEY DMD AND NICHOLAS CHANEY DDS (NORTHSHORE) LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-338-6449
Mailing Address - Street 1:735 ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1843
Mailing Address - Country:US
Mailing Address - Phone:985-624-2334
Mailing Address - Fax:
Practice Address - Street 1:735 ASBURY DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1843
Practice Address - Country:US
Practice Address - Phone:985-624-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental