Provider Demographics
NPI:1801388376
Name:CHIAFAIR, CATHERINE (DMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CHIAFAIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 BAYMEADOWS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7968
Mailing Address - Country:US
Mailing Address - Phone:904-739-3939
Mailing Address - Fax:
Practice Address - Street 1:9471 BAYMEADOWS RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7968
Practice Address - Country:US
Practice Address - Phone:904-739-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist