Individual
DR. JULIE A CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5100 GAMBLE DR, SUITE 125, ST LOUIS PARK, MN 55416-1521
(952) 465-0105
(952) 465-0106
Mailing address
5100 GAMBLE DR, SUITE 125, ST LOUIS PARK, MN 55416-1521
(952) 465-0105
(952) 465-0106
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11399
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000924472
UNITED CONCORDIA
MN
01
—
140122
U CARE
MN
01
—
15306
DORAL/DENTAQUEST
MN
01
—
3AI38CH
BLUE CROSS BLUE SHIELD
MN
01
—
850000116
MEDICARE PTAN
MN
01
—
P00841569
MEDICARE RAILROAD PTAN
MN
Enumeration date
02/07/2006
Last updated
10/05/2010
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