Provider Demographics
NPI:1548005705
Name:CHAVEZ, MARLA RENEE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:RENEE
Last Name:CHAVEZ
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 1:100 BOUCLE JEANNE CIR APT 147
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6617
Mailing Address - Country:US
Mailing Address - Phone:786-397-1588
Mailing Address - Fax:
Practice Address - Street 1:7326 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-6055
Practice Address - Country:US
Practice Address - Phone:407-704-2094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN292661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice