Provider Demographics
NPI:1952914970
Name:AZUL FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:AZUL FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:CHAVEZ-MAYORGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-510-0828
Mailing Address - Street 1:1305 PENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3769
Mailing Address - Country:US
Mailing Address - Phone:305-510-0828
Mailing Address - Fax:
Practice Address - Street 1:9605 CRITZERS SHOP RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:VA
Practice Address - Zip Code:22920-2416
Practice Address - Country:US
Practice Address - Phone:540-456-6571
Practice Address - Fax:540-456-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental