Healthcare Provider Details

I. General information

NPI: 1629154646
Provider Name (Legal Business Name): NANCY RAE CHAFFEE D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PEMBERTON HILL RD SUITE 102
APEX NC
27502-4267
US

IV. Provider business mailing address

1051 PEMBERTON HILL RD SUITE 102
APEX NC
27502-4267
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-4775
  • Fax: 919-387-9559
Mailing address:
  • Phone: 919-387-4775
  • Fax: 919-387-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7259
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: