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General NPI Number Information
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NPI Number | 1003196221
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Entity Type | Individual
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Provider Name | LUIS CHAVEZ DE PAZ DDS, MS, PHD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-1715
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Country | US
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Telephone | 860-679-2719
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Fax |
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Provider Business Mailing Address
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Address Line | 151 S HIGHLAND ST # 2
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1831
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Country | US
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Telephone | 860-801-0788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 741016
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License Number State | CT
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