Provider Demographics
NPI:1912161845
Name:EXUM, ANTONE CHAVEZ (DDS)
Entity type:Individual
Prefix:MR
First Name:ANTONE
Middle Name:CHAVEZ
Last Name:EXUM
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:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3749
Mailing Address - Country:US
Mailing Address - Phone:804-648-2020
Mailing Address - Fax:804-782-2215
Practice Address - Street 1:505 WEST LEIGH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3254
Practice Address - Country:US
Practice Address - Phone:804-648-2020
Practice Address - Fax:804-782-2215
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA69941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice