Provider Demographics
NPI:1891791612
Name:CHAVEZ, JENNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
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 1:36 VALLEY COURT
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094
Mailing Address - Country:US
Mailing Address - Phone:201-558-9100
Mailing Address - Fax:201-553-9845
Practice Address - Street 1:517 40TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-558-9100
Practice Address - Fax:201-553-9845
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2016-02-23
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
NJ22 DI 022618001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice