Provider Demographics
NPI:1649298639
Name:CHAVEZ, CARLOS ENRIQUE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9042 GARDEN GROVE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1370
Mailing Address - Country:US
Mailing Address - Phone:714-638-8662
Mailing Address - Fax:714-638-8664
Practice Address - Street 1:9042 GARDEN GROVE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1370
Practice Address - Country:US
Practice Address - Phone:714-638-8662
Practice Address - Fax:714-638-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist