Healthcare Provider Details

I. General information

NPI: 1497240808
Provider Name (Legal Business Name): CHELSEA ERIN KUYATH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 STATE FARM RD STE 103A
BOONE NC
28607-4862
US

IV. Provider business mailing address

870 STATE FARM RD STE 103A
BOONE NC
28607-4862
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-3333
  • Fax:
Mailing address:
  • Phone: 828-264-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11101
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: