Individual
MARTIN V CHANEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3205 WISCONSIN AVE, VICKSBURG, MS 39180-5350
(601) 634-6080
(601) 634-6081
Mailing address
111 VIRGINIA RDG, VICKSBURG, MS 39180-7712
(601) 634-6080
(601) 634-6081
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2007
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060033
—
MS
Enumeration date
12/14/2006
Last updated
07/08/2007
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