Provider Demographics
NPI:1093754467
Name:CHAVKIN, ROSS ORAN (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:ORAN
Last Name:CHAVKIN
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 1:425 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4713
Mailing Address - Country:US
Mailing Address - Phone:631-752-1033
Mailing Address - Fax:
Practice Address - Street 1:425 BROADHOLLOW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4713
Practice Address - Country:US
Practice Address - Phone:631-752-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1093754467Medicare PIN