Provider Demographics
NPI:1538331368
Name:CHAVEZ, LUZ A (DDS)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:A
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 98TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1735
Mailing Address - Country:US
Mailing Address - Phone:631-553-3356
Mailing Address - Fax:
Practice Address - Street 1:14415 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3623
Practice Address - Country:US
Practice Address - Phone:718-657-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165705OtherDORAL
NY02427076Medicaid