MEDICARE: MARK STEPHEN CHANEY 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	4415	LA

General Provider Information

NPI Number	:	1932294063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK STEPHEN CHANEY D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 13276
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70185-3276
Country	:	US
Telephone Number	:	504-861-2523
Fax Number	:	504-866-6404

Provider Business Practice Location Address
First Line	:	1407 S CARROLLTON AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-2809
Country	:	US
Telephone Number	:	504-861-2523
Fax Number	:	504-866-6404

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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