Provider Demographics
NPI:1881842615
Name:FENTON, CHELSEA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:B
Last Name:FENTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 W HILLSBOROUGH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9748
Mailing Address - Country:US
Mailing Address - Phone:321-253-9792
Mailing Address - Fax:321-253-9797
Practice Address - Street 1:11725 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9748
Practice Address - Country:US
Practice Address - Phone:321-253-9792
Practice Address - Fax:321-253-9797
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice