Provider Demographics
NPI:1851750426
Name:CHENET, DEREK (DDS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:CHENET
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 1:7331 OFFICE PARK PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8238
Mailing Address - Country:US
Mailing Address - Phone:321-253-3136
Mailing Address - Fax:
Practice Address - Street 1:7331 OFFICE PARK PL STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8238
Practice Address - Country:US
Practice Address - Phone:321-253-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN236901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice