MEDICARE: DR. JOHN RAYMOND CHACONAS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21185	TX
2	1223G0001X	General Practice Dentistry	5393	LA

General Provider Information

NPI Number	:	1316942337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RAYMOND CHACONAS D.D.S.

Provider Business Mailing Address
First Line	:	2513 FLYCATCHER COVE DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3915
Country	:	US
Telephone Number	:	281-337-5262
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 FM 517 RD W STE 204
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3924
Country	:	US
Telephone Number	:	281-337-5262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN RAYMOND CHACONAS D.D.S.” Practice Location

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