NPI 1649342064 · live from the CMS NPI Registry
Jose Antonio Chacon
Dentist, Orthodontics and Dentofacial Orthopedics in Mayfield Hts, OH. National Provider Identifier 1649342064, active.
NPI record
| NPI | 1649342064 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 5875 Landerbrook Dr Ste 250, Mayfield Hts, OH 44124 |
| Practice phone | 800-487-4867 |
| Mailing address | 125 E 13th St, # 1405, Chicago, IL 60605 |
| Enumerated | November 14, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 019-026092 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.