Provider Demographics
NPI:1184197063
Name:LUZ A CHAVEZ DDS II PC
Entity Type:Organization
Organization Name:LUZ A CHAVEZ DDS II PC
Other - Org Name:ARROWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL OFFICE MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-553-3356
Mailing Address - Street 1:816 E ARROWOOD RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-5818
Mailing Address - Country:US
Mailing Address - Phone:704-552-8332
Mailing Address - Fax:
Practice Address - Street 1:816 E ARROWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5818
Practice Address - Country:US
Practice Address - Phone:704-552-8332
Practice Address - Fax:704-503-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921743Medicaid