MEDICARE: J.THOMAS CHESS,DDS,INC.

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	261QD0000X	Dental Clinic/Center	17658	CA

General Provider Information

NPI Number	:	1912096215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.THOMAS CHESS,DDS,INC.

Provider Business Mailing Address
First Line	:	500 COLUMBIA ST
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1652
Country	:	US
Telephone Number	:	323-682-1133
Fax Number	:	323-682-1284

Provider Business Practice Location Address
First Line	:	500 COLUMBIA ST
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1652
Country	:	US
Telephone Number	:	323-682-1133
Fax Number	:	323-682-1284

Authorized Official
Title or Position	:	PRESIDENT-OWNER
Name	:	DR. JOSEPH THOMAS CHESS
Credential	:	D.D.S.
Telephone Number	:	323-682-1133

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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