Provider Demographics
NPI:1760535819
Name:CEDRIC C CHENET DDS PA
Entity Type:Organization
Organization Name:CEDRIC C CHENET DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHENET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-253-3136
Mailing Address - Street 1:7331 OFFICE PARK PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8239
Mailing Address - Country:US
Mailing Address - Phone:321-253-3136
Mailing Address - Fax:321-253-6411
Practice Address - Street 1:7331 OFFICE PARK PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8239
Practice Address - Country:US
Practice Address - Phone:321-253-3136
Practice Address - Fax:321-253-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty