Individual
INDRAJA CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
16401 IRONSTONE DR, EDMOND, OK 73013-6088
(405) 784-4822
Mailing address
1921 DEL SIMMONS DR, EDMOND, OK 73003-2427
(405) 719-9160
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7869
OK
Other
Enumeration date
05/24/2024
Last updated
05/24/2024
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