Healthcare Provider Details

I. General information

NPI: 1811150055
Provider Name (Legal Business Name): WESLEY J. CHLADNY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 O'HALLORN SUITE B
THOMPSONS STATION TN
37179
US

IV. Provider business mailing address

3632 RONSTADT RD
THOMPSONS STATION TN
37179-0620
US

V. Phone/Fax

Practice location:
  • Phone: 217-840-6271
  • Fax:
Mailing address:
  • Phone: 217-840-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.002246
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9946
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: