David E Chlysta, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15733 Issued in OH

Practice address

6693 N Chestnut Street
Suite 131-a
Ravenna, OH 44266-3922

Phone

(330) 296-3975

Fax

(330) 296-0990

NPI assigned

Feb 21, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902941594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6693 N CHESTNUT ST",
            "address_2": "SUITE 131-A",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442663922",
            "telephone_number": "330-296-3975",
            "fax_number": "330-296-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6693 N CHESTNUT STREET",
            "address_2": "SUITE 131-A",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442663922",
            "telephone_number": "330-296-3975",
            "fax_number": "330-296-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHLYSTA",
        "first_name": "DAVID",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "15733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Victor Chaung, MD
• Hannah Ruth Chilcot
• Child Health Services of Portage County
• Childrens Advantage
• Olivia Jean Chinn, DPT, PT
• Jennifer J Christley
• Roberta Christofaris, LSW
• Rebecca K Cibik, MSN, APRN, CPNP-PC
• Ronald J Cigany, PT
• City of Ravenna

• General Practice Dentistry in Ravenna, OH
• Providers in Ravenna, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.