Provider Demographics
NPI:1154034924
Name:GARCIA-CHAIDEZ, JOSUE ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSUE
Middle Name:ANTONIO
Last Name:GARCIA-CHAIDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DUKE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1520
Mailing Address - Country:US
Mailing Address - Phone:925-899-0271
Mailing Address - Fax:
Practice Address - Street 1:8085 FOUNTAIN MESA RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1591
Practice Address - Country:US
Practice Address - Phone:719-382-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002054071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty