Provider Demographics
NPI:1114277381
Name:CHAVEZ, CHRISTINE LE (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:T
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4014 E CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-9058
Mailing Address - Country:US
Mailing Address - Phone:818-667-1548
Mailing Address - Fax:
Practice Address - Street 1:6601 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:623-247-9742
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861295Medicaid