MEDICARE: JOSE L CHAVIANO JR

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	:	1902275647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE L CHAVIANO JR

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

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. JOSE LUIS CHAVIANO JR.
Credential	:	DMD
Telephone Number	:	305-967-2175

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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