Provider Demographics
NPI:1871102004
Name:CHAVEZ, SABRINA LOUISE (DDS)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:LOUISE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:L
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:201 RITCHIE RD APT 2201
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3009
Mailing Address - Country:US
Mailing Address - Phone:956-371-7451
Mailing Address - Fax:
Practice Address - Street 1:1115 N VALLEY MILLS DR # B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4425
Practice Address - Country:US
Practice Address - Phone:254-230-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist