Organization
KENNETH W CHANCEY DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH W CHANCEY DMD (OWNER/DENTIST)
(334) 347-0036
Entity
Organization
Contact information
Practice address
534 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-4012
(334) 347-0036
(334) 208-2217
Mailing address
534 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-4012
(334) 347-0036
(334) 208-2217
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
3091
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000825887
UNITED CONCORDIA
AL
05
—
009915475
—
AL
01
—
51091102
BLUE CROSS BLUE SHIELD
AL
Enumeration date
10/10/2012
Last updated
10/10/2012
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