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General NPI Number Information
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NPI Number | 1992093454
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Entity Type | Individual
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Provider Name | OMAR CHACON D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 5700 SW 97TH ST
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City | PINECREST
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State | FL
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Zip | 33156-2058
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Country | US
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Telephone | 787-731-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 511 6TH ST APT 4B
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City | BROOKLYN
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State | NY
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Zip | 11215-3668
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Country | US
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Telephone | 787-614-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN25563
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License Number State | FL
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