Provider Demographics
NPI:1902941594
Name:CHLYSTA, DAVID E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:CHLYSTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6693 N CHESTNUT ST
Mailing Address - Street 2:SUITE 131-A
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-296-3975
Mailing Address - Fax:330-296-0990
Practice Address - Street 1:6693 N CHESTNUT STREET
Practice Address - Street 2:SUITE 131-A
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-296-3975
Practice Address - Fax:330-296-0990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice