Provider Demographics
NPI:1295033843
Name:CHAVEZ, JUAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 N 780 E
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5532
Mailing Address - Country:US
Mailing Address - Phone:801-318-2289
Mailing Address - Fax:
Practice Address - Street 1:1256 S STATE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8237
Practice Address - Country:US
Practice Address - Phone:801-224-7182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3104344-99221223G0001X
TX278941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice