Provider Demographics
NPI:1114045192
Name:CHAVIANO-MORAN, ROSA II (DMD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:CHAVIANO-MORAN
Suffix:II
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 1:337 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2307
Mailing Address - Country:US
Mailing Address - Phone:732-291-0029
Mailing Address - Fax:
Practice Address - Street 1:353 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1285
Practice Address - Country:US
Practice Address - Phone:732-870-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist