MEDICARE: DR. TIMOTHY G CHASE DDS

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	1223G0001X	General Practice Dentistry	20683	OH

General Provider Information

NPI Number	:	1720300973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY G CHASE DDS

Provider Business Mailing Address
First Line	:	1241 E CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-4446
Country	:	US
Telephone Number	:	740-387-4804
Fax Number	:	740-382-9901

Provider Business Practice Location Address
First Line	:	1241 E CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-4446
Country	:	US
Telephone Number	:	740-387-4804
Fax Number	:	740-382-9901

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

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	02/15/2010

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