Provider Demographics
NPI:1437788270
Name:CHICHESTER, KENYATTA (RDH)
Entity type:Individual
Prefix:MRS
First Name:KENYATTA
Middle Name:
Last Name:CHICHESTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 HIGHWAY 20 SE STE H
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2087
Mailing Address - Country:US
Mailing Address - Phone:770-570-6399
Mailing Address - Fax:
Practice Address - Street 1:2239 HIGHWAY 20 SE STE H
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2087
Practice Address - Country:US
Practice Address - Phone:770-570-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012201124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH012201OtherDENTAL