Georgene Bernice Chase, DDS
Individual provider Active NPI Dentist · Mad River, CA
NPI 1922110337 · NPPES record last updated Oct 24, 2019
Key facts
- NPI
- 1922110337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 39138 (CA)
- Practice address
- 321 Van Duzen Rd
Mad River, CA 95526-9508 - Phone
- (707) 574-6616
- Fax
- (707) 574-6623
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2676 | NV | MD | Dentist |
| 39138 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smilerestore | Dentist | Current | Accepting new patients |
| The Wecare Group, Inc. | Past | Accepting new patients | |
| Frederick Reese Carlin Jr DDS Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2676 | NV | |
| Dentist | 122300000X | 39138 | CA | Yes |
Addresses
Primary practice location
321 Van Duzen Rd
Mad River, CA 95526-9508
Mailing address
PO Box 4
Mad River, CA 95552-0004
Phone (707) 574-6616
Other practice location 1
100 Horseshoe Lane
Weaverville, CA 96093-0960
Phone (530) 623-8888
Other providers in Mad River, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.