Provider Demographics
NPI:1467890301
Name:LUZ A CHAVEZ DDS PC
Entity Type:Organization
Organization Name:LUZ A CHAVEZ DDS PC
Other - Org Name:ALL FAMILY DENTISTRY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-847-0161
Mailing Address - Street 1:9912 MONROE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5416
Mailing Address - Country:US
Mailing Address - Phone:704-847-0161
Mailing Address - Fax:704-847-0163
Practice Address - Street 1:9912 MONROE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5416
Practice Address - Country:US
Practice Address - Phone:704-847-0161
Practice Address - Fax:704-847-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921743Medicaid