Provider Demographics
NPI:1497018188
Name:CHAVEZ, KEELY JANE (DDS)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:JANE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:JANE
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7905 MARBLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7886
Mailing Address - Country:US
Mailing Address - Phone:505-222-4600
Mailing Address - Fax:
Practice Address - Street 1:7905 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7886
Practice Address - Country:US
Practice Address - Phone:505-222-4600
Practice Address - Fax:505-232-5720
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN42501223G0001X
NMDD38311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice