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General NPI Number Information
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NPI Number | 1972278000
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Entity Type | Individual
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Provider Name | MICHAEL EUGENIO CHEW DMD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | BLDG 38801 ACADEMIC DRIVE SUITE B & C
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City | FORT GORDON
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State | GA
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Zip | 30905-5660
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Country | US
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Telephone | 706-814-4764
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 ANTHEM AVE APT Q
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City | AUGUSTA
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State | GA
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Zip | 30909-0033
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Country | US
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Telephone | 925-719-5053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9904
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License Number State | SC
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