Healthcare Provider Details

I. General information

NPI: 1992093454
Provider Name (Legal Business Name): OMAR CHACON D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13019 W LINEBAUGH AVE STE 102
WESTCHASE FL
33626-4507
US

IV. Provider business mailing address

13019 W LINEBAUGH AVE STE 102
WESTCHASE FL
33626-4507
US

V. Phone/Fax

Practice location:
  • Phone: 813-730-8890
  • Fax: 813-730-8895
Mailing address:
  • Phone: 813-730-8890
  • Fax: 813-730-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN25563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: