Provider Demographics
NPI:1891835112
Name:CHIOVELLI, DAVID R (DD,LD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:CHIOVELLI
Suffix:
Gender:M
Credentials:DD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16130 SE 82ND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-657-6500
Mailing Address - Fax:503-557-0412
Practice Address - Street 1:16130 SE 82ND DRIVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-657-6500
Practice Address - Fax:503-557-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 00000379122400000X
ORDTDO838758122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDT-DO838758OtherDENTURIST BOARD OF H