Provider Demographics
NPI:1306458005
Name:CHAVEZ, CAROL (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23252 HAPPY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2661
Mailing Address - Country:US
Mailing Address - Phone:661-259-5840
Mailing Address - Fax:
Practice Address - Street 1:24218 VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5391
Practice Address - Country:US
Practice Address - Phone:661-288-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1051721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice