Provider Demographics
NPI:1114361334
Name:CHAVIANO, IBIS (DDS)
Entity type:Individual
Prefix:
First Name:IBIS
Middle Name:
Last Name:CHAVIANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 PALM AVE
Practice Address - Street 2:SUITE DD
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4424
Practice Address - Country:US
Practice Address - Phone:305-456-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 215781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice