Provider Demographics
NPI:1851447296
Name:CHAVEZ, DANIEL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:CHAVEZ
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 1:7161 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:323-249-7565
Practice Address - Street 1:7161 EAST AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5915
Practice Address - Country:US
Practice Address - Phone:323-564-2444
Practice Address - Fax:323-249-7565
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53199Medicaid