Healthcare Provider Details

I. General information

NPI: 1700929486
Provider Name (Legal Business Name): PAUL JASON CHANEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CODY ROAD
WHITE PINE TN
37890
US

IV. Provider business mailing address

3272 HIGHWAY 15
WHITESBURG KY
41858-8566
US

V. Phone/Fax

Practice location:
  • Phone: 865-397-5422
  • Fax:
Mailing address:
  • Phone: 502-572-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8609
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: