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General NPI Number Information
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NPI Number | 1851364392
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Entity Type | Individual
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Provider Name | JULIE A CHAVEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 5100 GAMBLE DR SUITE 125
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1521
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Country | US
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Telephone | 952-465-0105
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Fax | 952-465-0106
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Provider Business Mailing Address
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Address Line | 5100 GAMBLE DR SUITE 125
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1521
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Country | US
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Telephone | 952-465-0105
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Fax | 952-465-0106
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D11399
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License Number State | MN
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