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General NPI Number Information
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NPI Number | 1447374129
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Entity Type | Organization
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Legal Business Name | CHAUNCY F. NELSON DDS, PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 2135 VALLEYGATE DR STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3751
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Country | US
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Telephone | 910-860-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 VALLEYGATE DR STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3751
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Country | US
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Telephone | 910-860-1991
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. CHAUNCY FITCH NELSON
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Credential | DDS
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Telephone | 910-860-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5591
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License Number State | NC
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