Provider Demographics
NPI:1013037191
Name:JOSEPH G CHIAFAIR DDS MS PA
Entity Type:Organization
Organization Name:JOSEPH G CHIAFAIR DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:CHIAFAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PA
Authorized Official - Phone:904-739-3939
Mailing Address - Street 1:9471 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-739-3939
Mailing Address - Fax:904-739-1381
Practice Address - Street 1:9471 BAYMEADOWS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-739-3939
Practice Address - Fax:904-739-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAC9558442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty