Provider Demographics
NPI:1942751789
Name:RICARDO CHAVEZ DDS PLLC
Entity Type:Organization
Organization Name:RICARDO CHAVEZ DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-849-6380
Mailing Address - Street 1:11365 MONTWOOD DR
Mailing Address - Street 2:STE. B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3854
Mailing Address - Country:US
Mailing Address - Phone:915-849-6380
Mailing Address - Fax:915-849-6330
Practice Address - Street 1:11365 MONTWOOD DR
Practice Address - Street 2:STE. B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3854
Practice Address - Country:US
Practice Address - Phone:915-849-6380
Practice Address - Fax:915-849-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289222601Medicaid