MEDICARE: DR. CHELSEA B FENTON D.M.D.

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	DN 18265	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881842615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEA B FENTON D.M.D.

Provider Business Mailing Address
First Line	:	11725 W HILLSBOROUGH AVE
Second Line	:	SUITE 205
City	:	TAMPA
State	:	FL
Zip	:	33635-9748
Country	:	US
Telephone Number	:	321-253-9792
Fax Number	:	321-253-9797

Provider Business Practice Location Address
First Line	:	11725 W HILLSBOROUGH AVE
Second Line	:	SUITE 205
City	:	TAMPA
State	:	FL
Zip	:	33635-9748
Country	:	US
Telephone Number	:	321-253-9792
Fax Number	:	321-253-9797

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	06/10/2013

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