Healthcare Provider Details

I. General information

NPI: 1912161845
Provider Name (Legal Business Name): ANTONE CHAVEZ EXUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WEST LEIGH ST SUITE 106
RICHMOND VA
23220-3254
US

IV. Provider business mailing address

PO BOX 3749
GLEN ALLEN VA
23060-3749
US

V. Phone/Fax

Practice location:
  • Phone: 804-648-2020
  • Fax: 804-782-2215
Mailing address:
  • Phone: 804-648-2020
  • Fax: 804-782-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6994
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: