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General NPI Number Information
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NPI Number | 1831619642
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL ARTS, P.C.
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 2819 HIGHWAY 34 E
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City | NEWNAN
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State | GA
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Zip | 30265-1331
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Country | US
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Telephone | 770-254-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 90 GLENDA TRCE STE F PMB 418
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City | NEWNAN
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State | GA
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Zip | 30265-3868
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLEY CHENEY III
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Credential | DMD
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Telephone | 770-254-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013135
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License Number State | GA
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