MEDICARE: DR. CHESTER L. LAYNE D.D.S.

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	3430-07	MS

General Provider Information

NPI Number	:	1952577835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHESTER L. LAYNE D.D.S.

Provider Business Mailing Address
First Line	:	800 OHIO AVE
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-7200
Country	:	US
Telephone Number	:	662-624-2504
Fax Number	:	662-627-3629

Provider Business Practice Location Address
First Line	:	510 HIGHWAY 322
Second Line	:	P O DRAWER 1216
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-4717
Country	:	US
Telephone Number	:	662-624-2504
Fax Number	:	662-627-3629

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	10/08/2009

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