Healthcare Provider Details

I. General information

NPI: 1073814810
Provider Name (Legal Business Name): LEE C. CHEWNING DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S PARK ST
ROCHESTER PA
15074-2217
US

IV. Provider business mailing address

191 S PARK ST
ROCHESTER PA
15074-2217
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-6500
  • Fax: 724-774-6962
Mailing address:
  • Phone: 724-774-6500
  • Fax: 724-774-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS022859L
License Number StatePA

VIII. Authorized Official

Name: LEE CAIN CHEWNING
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 724-774-6500