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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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