Healthcare Provider Details

I. General information

NPI: 1396460705
Provider Name (Legal Business Name): S CHIMENTI & ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 PROVIDENCE RD STE 300
CHARLOTTE NC
28277-9730
US

IV. Provider business mailing address

8128 PROVIDENCE RD STE 300
CHARLOTTE NC
28277-9730
US

V. Phone/Fax

Practice location:
  • Phone: 704-550-3980
  • Fax: 704-550-3985
Mailing address:
  • Phone: 704-550-3980
  • Fax: 704-550-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY COHEN
Title or Position: COO
Credential:
Phone: 704-246-8971