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General NPI Number Information
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NPI Number | 1144655143
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Entity Type | Individual
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Provider Name | STEPHANIE BURGESS CHAVES D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 10601 SAN JOSE BLVD SUITE 116
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8232
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Country | US
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Telephone | 904-483-3027
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Fax |
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Provider Business Mailing Address
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Address Line | 2054 RIVERSIDE AVE APT. 5207
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4428
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Country | US
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Telephone | 304-290-2722
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20398
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License Number State | FL
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