Provider Demographics
NPI:1831958214
Name:CHAVEZ, JUAN (DMD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LAWRENCE ST APT 19A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3876
Mailing Address - Country:US
Mailing Address - Phone:954-756-1440
Mailing Address - Fax:
Practice Address - Street 1:505 CLAREMONT PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8304
Practice Address - Country:US
Practice Address - Phone:718-299-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program