MEDICARE: CHIARAVALLI & MAXSON DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1295031011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIARAVALLI & MAXSON DDS, PLLC

Provider Business Mailing Address
First Line	:	1500 W SAGINAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48915-1380
Country	:	US
Telephone Number	:	517-485-5627
Fax Number	:	517-485-0169

Provider Business Practice Location Address
First Line	:	1500 W SAGINAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48915-1380
Country	:	US
Telephone Number	:	517-485-5627
Fax Number	:	517-485-0169

Authorized Official
Title or Position	:	DENTIST/MEMBER
Name	:	DR. PETER CARMEN CHIARAVALLI
Credential	:	D.D.S.
Telephone Number	:	517-485-5738

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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