Provider Demographics
NPI:1285024109
Name:NOVINCE, CHAD MICHAEL (DDS, MSD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:NOVINCE
Suffix:
Gender:M
Credentials:DDS, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 ASHLEY AVE
Mailing Address - Street 2:BSB - ROOM 241
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-5070
Mailing Address - Country:US
Mailing Address - Phone:843-792-0203
Mailing Address - Fax:843-792-6626
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:DENTAL - ROUTING CODE 160
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-577-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014734122300000X
MI2901020500122300000X
SC8335 SP-(PERIO) 8381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist