Healthcare Provider Details

I. General information

NPI: 1881539476
Provider Name (Legal Business Name): LANDY PACHECO CHAVIANO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18070 S TAMIAMI TRL # 101
FORT MYERS FL
33908-4602
US

IV. Provider business mailing address

18070 S TAMIAMI TRL # 101
FORT MYERS FL
33908-4602
US

V. Phone/Fax

Practice location:
  • Phone: 239-451-5721
  • Fax:
Mailing address:
  • Phone: 786-370-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: