Provider Demographics
NPI:1043358211
Name:DENOLO-CHAVEZ, MARIA LOVELL DEGOMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA LOVELL
Middle Name:DEGOMA
Last Name:DENOLO-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 1:8615 KNOTT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3841
Mailing Address - Country:US
Mailing Address - Phone:714-995-9301
Mailing Address - Fax:
Practice Address - Street 1:8615 KNOTT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3841
Practice Address - Country:US
Practice Address - Phone:714-995-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice