MEDICARE: CHAUNCY F. NELSON DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5591	NC

General Provider Information

NPI Number	:	1447374129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAUNCY F. NELSON DDS, PA

Provider Business Mailing Address
First Line	:	2135 VALLEYGATE DR STE 201
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3751
Country	:	US
Telephone Number	:	910-860-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 VALLEYGATE DR STE 201
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3751
Country	:	US
Telephone Number	:	910-860-1991
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. CHAUNCY FITCH NELSON
Credential	:	DDS
Telephone Number	:	910-860-1991

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/19/2022

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