Individual
DR. GUILLERMO ENRIQUE CHACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2910 S MERIDIAN, SUITE 120, PUYALLUP, WA 98373-1585
(253) 445-0022
(253) 445-0979
Mailing address
2910 S MERIDIAN, SUITE 120, PUYALLUP, WA 98373-1585
(253) 445-0022
(253) 445-0979
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE 60063175
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2237985
BCMH
OH
05
—
2237985
—
WA
01
—
311203750028
CARESOURCE
OH
01
—
CH4046621
MEDICARE ID TYPE UNSPECIFIED PROVIDER
WA
Enumeration date
11/08/2006
Last updated
04/10/2017
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