Provider Demographics
NPI:1225736697
Name:CHAVEZ, AMARINA ROSE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:AMARINA
Middle Name:ROSE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5236
Mailing Address - Country:US
Mailing Address - Phone:440-221-6564
Mailing Address - Fax:
Practice Address - Street 1:6222 NE 74TH ST # 8158
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
Practice Address - Country:US
Practice Address - Phone:206-543-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program