Provider Demographics
NPI:1114990322
Name:CHAVIS, DELWYNE LEE
Entity Type:Individual
Prefix:DR
First Name:DELWYNE
Middle Name:LEE
Last Name:CHAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 HALLS CHANCE LN
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1307
Mailing Address - Country:US
Mailing Address - Phone:443-327-6852
Mailing Address - Fax:
Practice Address - Street 1:5800 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3607
Practice Address - Country:US
Practice Address - Phone:410-433-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist