Leticia Chavez

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109948 Issued in CA

Practice address

6315 Commerce Blvd
Rohnert Park, CA 94928-2403

Phone

(707) 490-9282

NPI assigned

Apr 2, 2021

Last updated

Jun 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wilsonville Smiles PC

  dba Wilsonville Smiles Dentistry

  • General Practice Dentistry
  • Wilsonville, OR
  • NPI 1346516192
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1205415767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6315 COMMERCE BLVD",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282403",
            "telephone_number": "707-490-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6315 COMMERCE BLVD",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282403",
            "telephone_number": "707-490-9282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30040 SW Boones Ferry Rd Ste 20",
            "address_purpose": "LOCATION",
            "city": "Wilsonville",
            "state": "OR",
            "postal_code": "970708910",
            "country_code": "US",
            "telephone_number": "503-682-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393098",
            "country_code": "US",
            "telephone_number": "503-494-8211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "LETICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jace Michael Chabot
• Challee Young (Apollo Respiratory Services)
• Erin Marie Charles, MA, CCC SLP
• Monica Leann Chatigny, AMFT
• Chavez and Paulovich Dental Corporation (Gold Coast Family Dentistry)
• Aaron Cherkas
• Jian Cheung, R.PH.
• Robert Y Chiang, DDS
• David R. Chipkin, MD
• Christine I Dimaio (Irenes Fitting Room)

• General Practice Dentistry in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.