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General NPI Number Information
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NPI Number | 1730586355
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Entity Type | Organization
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Legal Business Name | JUAN C. CHAVEZ, D.M.D., P.L.L.C
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 2520 N UNIVERSITY AVE STE 101
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City | PROVO
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State | UT
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Zip | 84604-6081
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Country | US
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Telephone | 801-426-6255
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 N UNIVERSITY AVE STE 101
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City | PROVO
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State | UT
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Zip | 84604-6081
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Country | US
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Telephone | 801-426-6255
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MRS. JESSIE L KITCHEN
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Credential |
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Telephone | 801-305-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3104344
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License Number State | UT
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