Provider Demographics
NPI:1841827177
Name:MATSUURA, CHET THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:CHET
Middle Name:THOMAS
Last Name:MATSUURA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N PETERS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4925
Mailing Address - Country:US
Mailing Address - Phone:865-691-0918
Mailing Address - Fax:
Practice Address - Street 1:248 N PETERS RD STE 1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4925
Practice Address - Country:US
Practice Address - Phone:865-691-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery