Healthcare Provider Details

I. General information

NPI: 1578546164
Provider Name (Legal Business Name): MAURICIO CHAVES CAROTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

777 N AIR DEPOT BLVD
MIDWEST CITY OK
73110-3786
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2000
  • Fax:
Mailing address:
  • Phone: 405-455-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number047917-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number047917-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: