Provider Demographics
NPI:1356701163
Name:CHESNEY DENTISTRY NORTH
Entity type:Organization
Organization Name:CHESNEY DENTISTRY NORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-966-7441
Mailing Address - Street 1:3019 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1867
Mailing Address - Country:US
Mailing Address - Phone:865-688-4112
Mailing Address - Fax:865-689-8460
Practice Address - Street 1:3019 SANDERS DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1867
Practice Address - Country:US
Practice Address - Phone:865-688-4112
Practice Address - Fax:865-689-8460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESNEY DENTISTRY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1629480199OtherNPPES
TN1336274547OtherNPPES
TN1447383468OtherNPPES