Provider Demographics
NPI:1790414415
Name:BETHEA, CHLOE ELYSSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:ELYSSE
Last Name:BETHEA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W STATE HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-9211
Mailing Address - Country:US
Mailing Address - Phone:936-714-5129
Mailing Address - Fax:
Practice Address - Street 1:3811 W STATE HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-9211
Practice Address - Country:US
Practice Address - Phone:903-229-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist