Provider Demographics
NPI:1134264518
Name:CHAVES, JOHN MANUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MANUEL
Last Name:CHAVES
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 1:5312 COMERCIO LANE #A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-999-2707
Mailing Address - Fax:818-703-1998
Practice Address - Street 1:5312 COMERCIO LANE #A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-999-2707
Practice Address - Fax:818-703-1998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist