Provider Demographics
NPI:1215344148
Name:CAVAZOS, CHRISTEN LARAE
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:LARAE
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 JAGER DR NE
Mailing Address - Street 2:C-1
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5709
Mailing Address - Country:US
Mailing Address - Phone:505-867-1442
Mailing Address - Fax:505-867-1438
Practice Address - Street 1:4405 JAGER DR NE
Practice Address - Street 2:C-1
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5709
Practice Address - Country:US
Practice Address - Phone:505-867-1442
Practice Address - Fax:506-867-1438
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH 2504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist