Organization
CHACON DENTAL GROUP
Active
Organization
CHACON DENTAL GROUP
Active
Other names
Aurora Orthodontics and Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE CHACON DDS.MD (ORTHODONTIST)
(630) 338-1658
Entity
Organization
Contact information
Practice address
3535 E NEW YORK ST, AURORA, IL 60504-4465
(630) 338-1652
(630) 689-1358
Mailing address
3535 E NEW YORK ST, AURORA, IL 60504-4465
(630) 338-1652
(630) 689-1358
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019026187
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019026092
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065880272
—
IL
05
—
200384161
—
IL
Enumeration date
09/23/2014
Last updated
09/23/2014
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