Individual
DR. OMAR CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
5700 SW 97TH ST, PINECREST, FL 33156-2058
(787) 731-6622
Mailing address
511 6TH ST APT 4B, BROOKLYN, NY 11215-3668
(787) 614-5000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN25563
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/19/2011
Last updated
06/15/2021
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