Provider Demographics
NPI:1912062969
Name:EDWARD R CHAVEZ DDS PC
Entity Type:Organization
Organization Name:EDWARD R CHAVEZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-510-0731
Mailing Address - Street 1:200 E WILLOW AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5447
Mailing Address - Country:US
Mailing Address - Phone:630-510-0731
Mailing Address - Fax:630-510-9779
Practice Address - Street 1:200 E WILLOW AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5463
Practice Address - Country:US
Practice Address - Phone:630-510-0731
Practice Address - Fax:630-510-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190175161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty