Provider Demographics
NPI:1497019640
Name:POWELL, JOSEPH CHANCE (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHANCE
Last Name:POWELL
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 1:373 BOONE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4934
Mailing Address - Country:US
Mailing Address - Phone:828-291-6103
Mailing Address - Fax:229-241-1900
Practice Address - Street 1:373 BOONE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4934
Practice Address - Country:US
Practice Address - Phone:828-264-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1086122300000X
GADN0149761223P0221X
NC096931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN014976OtherDENTAL LICENSE
NC09693OtherDENTAL LICENSE