Provider Demographics
NPI:1063451177
Name:CHAVEZ, HUGO E (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:E
Last Name:CHAVEZ
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 1:847 SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7718
Mailing Address - Country:US
Mailing Address - Phone:407-855-6616
Mailing Address - Fax:407-855-6186
Practice Address - Street 1:847 SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7718
Practice Address - Country:US
Practice Address - Phone:407-855-6616
Practice Address - Fax:407-855-6186
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist