Provider Demographics
NPI:1891892584
Name:HSU, CHESTER Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:Y
Last Name:HSU
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 1:7807 FRONT NINE DR
Mailing Address - Street 2:
Mailing Address - City:STOKESDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27357-9407
Mailing Address - Country:US
Mailing Address - Phone:916-761-6455
Mailing Address - Fax:
Practice Address - Street 1:2643 RANDLEMAN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5153
Practice Address - Country:US
Practice Address - Phone:336-544-2758
Practice Address - Fax:910-338-3031
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45877OtherSTATE LICENSE #
CAD45877OtherDDHF PROVIDER #
CAG92444-01OtherMEDI-CAL PROVIDER #