MEDICARE: DANIEL ANTONIO CHAVEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12870290-9922	UT

General Provider Information

NPI Number	:	1720718232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ANTONIO CHAVEZ DDS

Provider Business Mailing Address
First Line	:	539 W 230 N
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-3060
Country	:	US
Telephone Number	:	801-540-5648
Fax Number	:

Provider Business Practice Location Address
First Line	:	2667 N WASHINGTON BLVD
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2240
Country	:	US
Telephone Number	:	801-782-3920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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