Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 019020371 | IL |
Y | 1223P0700X | Prosthodontist | DNF000355 | GA |
NPI | 1134108582 |
---|---|
Provider Name | Dr. Edward Robert Chesla |
First Address | Augusta, GA 30912-0001 |
Second Address | Augusta, GA 30912-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 22/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
878289389A | (05) | GA |