Provider Demographics
NPI:1255168282
Name:KEVIN CHIDESTER, D.M.D., P.L.L.C.
Entity type:Organization
Organization Name:KEVIN CHIDESTER, D.M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIDESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-254-1322
Mailing Address - Street 1:3012 BETHWICKE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6807 KNIGHTDALE BLVD STE E&F
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6562
Practice Address - Country:US
Practice Address - Phone:978-254-1322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental