Provider Demographics
NPI:1598111643
Name:CHAY, EUNICE LI (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:LI
Last Name:CHAY
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 E PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1838
Mailing Address - Country:US
Mailing Address - Phone:470-799-2919
Mailing Address - Fax:
Practice Address - Street 1:4122 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1838
Practice Address - Country:US
Practice Address - Phone:470-799-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist