Provider Demographics
NPI:1114235264
Name:LUZ A CHAVEZ DDS PC
Entity Type:Organization
Organization Name:LUZ A CHAVEZ DDS PC
Other - Org Name:ALL FAMILY DENTISTRY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:II
Authorized Official - Credentials:SM
Authorized Official - Phone:704-776-4278
Mailing Address - Street 1:1307 E FRANKLIN ST # TSUITEC
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5196
Mailing Address - Country:US
Mailing Address - Phone:704-776-4278
Mailing Address - Fax:704-776-4279
Practice Address - Street 1:1307 E FRANKLIN ST # TSUITEC
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5196
Practice Address - Country:US
Practice Address - Phone:704-776-4278
Practice Address - Fax:704-776-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty