MEDICARE: NICHOLAS JAMES CHAUVIN DDS PC

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	051508	NY

General Provider Information

NPI Number	:	1760684500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS JAMES CHAUVIN DDS PC

Provider Business Mailing Address
First Line	:	516 VISCHER-FERRY ROAD
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065
Country	:	US
Telephone Number	:	518-371-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 VISCHER FERRY RD
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-1656
Country	:	US
Telephone Number	:	518-371-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLAS JAMES CHAUVIN
Credential	:	DDS
Telephone Number	:	518-371-2500

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	05/21/2008

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