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General NPI Number Information
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NPI Number | 1952293870
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Entity Type | Organization
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Legal Business Name | CHACON ORTHODONTICS PLLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 510 WESTBROOK AVE
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City | BRANDON
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State | FL
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Zip | 33511-5316
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Country | US
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Telephone | 786-929-6486
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Fax |
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Provider Business Mailing Address
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Address Line | 13019 W LINEBAUGH AVE STE 102
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City | WESTCHASE
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State | FL
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Zip | 33626-4507
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Country | US
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Telephone | 786-929-6486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OMAR CHACON
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Credential | DMD
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Telephone | 786-929-6486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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