MEDICARE: DR. JOSE LUIS CHAVIANO JR. D.M.D

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	DN21485	FL

General Provider Information

NPI Number	:	1487010245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS CHAVIANO JR. D.M.D

Provider Business Mailing Address
First Line	:	1407 W 38TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4745
Country	:	US
Telephone Number	:	305-967-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 CRANDON BLVD
Second Line	:	SUITE 104
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-1543
Country	:	US
Telephone Number	:	305-361-5493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	05/17/2016

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Directions to “ DR. JOSE LUIS CHAVIANO JR. D.M.D” Practice Location

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