Individual
SHAUN CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2036 S MILLER LN STE B, CATOOSA, OK 74015-1539
(918) 937-7660
Mailing address
2714 LAMOND HILL AVE, EDMOND, OK 73034-6979
(405) 317-5625
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7733
OK
Other
Enumeration date
10/09/2023
Last updated
11/20/2024
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