=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912161845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONE CHAVEZ EXUM DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2008
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 WEST LEIGH ST SUITE 106
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23220-3254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-648-2020
-----------------------------------------------------
Fax | 804-782-2215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3749
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23060-3749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-648-2020
-----------------------------------------------------
Fax | 804-782-2215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6994
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------