Provider Demographics
NPI:1427574730
Name:CHAVES DE SOUZA, LETICIA (DDS, MS, PHD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CHAVES DE SOUZA
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 KIRBY DR APT 133
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4364
Mailing Address - Country:US
Mailing Address - Phone:832-310-4591
Mailing Address - Fax:
Practice Address - Street 1:7550 KIRBY DR APT 133
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4364
Practice Address - Country:US
Practice Address - Phone:832-310-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics