Healthcare Provider Details

I. General information

NPI: 1235681552
Provider Name (Legal Business Name): WALTER C. CHITWOOD JR. DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W CLARK BLVD
MURFREESBORO TN
37129-2340
US

IV. Provider business mailing address

1110 W CLARK BLVD
MURFREESBORO TN
37129-2340
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-8771
  • Fax: 615-893-8781
Mailing address:
  • Phone: 615-893-8771
  • Fax: 615-893-8781

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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER C. CHITWOOD JR.
Title or Position: OWNER/ DENTIST
Credential: DDS
Phone: 615-893-8771