Individual
DR. ROGER WILLIAM CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1350 MACKEY BRANCH DRIVE, SUITE 110, CHATTANOOGA, TN 37421
(423) 296-8210
(423) 296-8292
Mailing address
1350 MACKEY BRANCH DRIVE, SUITE 110, CHATTANOOGA, TN 37421
(423) 296-8210
(423) 296-8292
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS5132
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
MS34149
TN
Other
Enumeration date
01/09/2006
Last updated
07/28/2010
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