Provider Demographics
NPI:1609857267
Name:CHIAFAIR, JOSEPH GERARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:CHIAFAIR
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 1:9471 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7932
Mailing Address - Country:US
Mailing Address - Phone:904-739-3939
Mailing Address - Fax:904-739-1381
Practice Address - Street 1:9471 BAYMEADOWS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7932
Practice Address - Country:US
Practice Address - Phone:904-739-3939
Practice Address - Fax:904-739-1381
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist