Kenneth W Chancey DMD LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

3091 Issued in AL

Legal business name

KENNETH W CHANCEY DMD LLC

Practice address

534 Boll Weevil Cir
Enterprise, AL 36330-4012

Phone

(334) 347-0036

Fax

(334) 208-2217

NPI assigned

Oct 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth W Chancey, DMD

Title

Owner/Dentist

Phone

(334) 347-0036

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1083966386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 BOLL WEEVIL CIR",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363304012",
            "telephone_number": "334-347-0036",
            "fax_number": "334-208-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 BOLL WEEVIL CIR",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363304012",
            "telephone_number": "334-347-0036",
            "fax_number": "334-208-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH W CHANCEY DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "CHANCEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "334-347-0036",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AL",
            "license": "3091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009915475",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51091102",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000825887",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly F Jordan, M.D.
• Lawrence C Katz, PH. D.
• Madison Paige Kelley, MAT, LAT, ATC
• Anabeth Gilley Kendrick, M.S., CCC-SLP
• Amy B Kennedy, AUDIOLOGIST
• Bailey Renate Kennington
• Leeann McAliley Kettunen, MD
• William Kettunen, MD
• Leah Kidd, LMT
• Levi J King, FNP-C

• Preferred Provider Organization in Enterprise, AL
• Providers in Enterprise, AL by specialty
• Preferred Provider Organization in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.