Provider Demographics
NPI:1295031011
Name:CHIARAVALLI & MAXSON DDS, PLLC
Entity Type:Organization
Organization Name:CHIARAVALLI & MAXSON DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:CHIARAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-485-5738
Mailing Address - Street 1:1500 W SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1380
Mailing Address - Country:US
Mailing Address - Phone:517-485-5627
Mailing Address - Fax:517-485-0169
Practice Address - Street 1:1500 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1380
Practice Address - Country:US
Practice Address - Phone:517-485-5627
Practice Address - Fax:517-485-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty