Provider Demographics
NPI:1821166836
Name:CHAVEZ LUNA, ELISA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:MARIE
Last Name:CHAVEZ LUNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:MARIE
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:155 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2919
Mailing Address - Country:US
Mailing Address - Phone:415-749-3387
Mailing Address - Fax:
Practice Address - Street 1:155 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2919
Practice Address - Country:US
Practice Address - Phone:415-749-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist