MEDICARE: DR. CHADWICK JENNINGS GOLDEN DMD

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	122300000X	Dentist	3212	SC

General Provider Information

NPI Number	:	1417180613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHADWICK JENNINGS GOLDEN DMD

Provider Business Mailing Address
First Line	:	19 SHELTER COVE LN
Second Line	:	SUITE#104 AT WATERSEDGE
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3520
Country	:	US
Telephone Number	:	843-842-2500
Fax Number	:	842-686-3444

Provider Business Practice Location Address
First Line	:	19 SHELTER COVE LN
Second Line	:	SUITE#104 AT WATERSEDGE
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3520
Country	:	US
Telephone Number	:	843-842-2500
Fax Number	:	842-686-3444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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