Provider Demographics
NPI:1255105508
Name:R. TATE CHAUNCEY DMD MSD, PLLC
Entity type:Organization
Organization Name:R. TATE CHAUNCEY DMD MSD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TATE
Authorized Official - Last Name:CHAUNCEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:702-306-1830
Mailing Address - Street 1:172 BRIGHTON HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0527
Mailing Address - Country:US
Mailing Address - Phone:702-306-1830
Mailing Address - Fax:
Practice Address - Street 1:1465 E LAKE MEAD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-4631
Practice Address - Country:US
Practice Address - Phone:702-306-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics