Individual
DR. CHAZ M AINSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
613 WATAUGA ST, KINGSPORT, TN 37660-4429
(423) 247-7741
(423) 630-0105
Mailing address
613 WATAUGA ST, KINGSPORT, TN 37660-4429
(423) 247-7741
(423) 630-0105
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11386
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800833684
DRIVERS LICENSE
MS
Enumeration date
07/21/2020
Last updated
07/21/2020
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