Individual
DR. CHETAN SHIVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
301 E LOHMAN AVE, LAS CRUCES, NM 88001-3667
(505) 524-4900
(505) 524-8300
Mailing address
301 E LOHMAN AVE, LAS CRUCES, NM 88001-3667
(505) 524-4900
(505) 524-8300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2480
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000N0238
—
NM
05
—
164588
—
NM
Enumeration date
01/21/2007
Last updated
07/09/2007
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