Provider Demographics
NPI:1639337983
Name:ANTHONY R. CHESLOCK DDS,PA
Entity Type:Organization
Organization Name:ANTHONY R. CHESLOCK DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHESLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-799-1564
Mailing Address - Street 1:1831 N BELCHER RD STE B1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1442
Mailing Address - Country:US
Mailing Address - Phone:727-799-1564
Mailing Address - Fax:727-725-1268
Practice Address - Street 1:1831 N BELCHER RD STE B1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1442
Practice Address - Country:US
Practice Address - Phone:727-799-1564
Practice Address - Fax:727-725-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty