MEDICARE: CHATTANOOGA PERIODONTICS & DENTAL IMPLANTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DS9462	TN
2	1223P0300X	Periodontics	DS3107	TN

General Provider Information

NPI Number	:	1063562460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATTANOOGA PERIODONTICS & DENTAL IMPLANTS, PC

Provider Business Mailing Address
First Line	:	951 RIVERFRONT PKWY
Second Line	:	STE 102
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2185
Country	:	US
Telephone Number	:	423-756-2450
Fax Number	:	423-756-5451

Provider Business Practice Location Address
First Line	:	951 RIVERFRONT PKWY
Second Line	:	STE 102
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2185
Country	:	US
Telephone Number	:	423-756-2450
Fax Number	:	423-756-5451

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES BAKER FELTS III
Credential	:	D.D.S., M.S.D
Telephone Number	:	423-756-2450

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	02/28/2017

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