Provider Demographics
NPI:1346916749
Name:CHAUNCY F. NELSON DDS, PA II
Entity Type:Organization
Organization Name:CHAUNCY F. NELSON DDS, PA II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-845-2900
Mailing Address - Street 1:301 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3298
Mailing Address - Country:US
Mailing Address - Phone:910-878-5796
Mailing Address - Fax:
Practice Address - Street 1:301 BIRCH ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3298
Practice Address - Country:US
Practice Address - Phone:910-878-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty