Provider Demographics
NPI:1366657397
Name:DECHAVEZ, GIL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:A
Last Name:DECHAVEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4437
Mailing Address - Country:US
Mailing Address - Phone:718-271-6148
Mailing Address - Fax:718-271-6164
Practice Address - Street 1:8812 55TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4437
Practice Address - Country:US
Practice Address - Phone:718-271-6148
Practice Address - Fax:718-271-6164
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice