Provider Demographics
NPI:1023192416
Name:CHICCHON, RAMON (DDS)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:CHICCHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 W BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3011
Mailing Address - Country:US
Mailing Address - Phone:209-835-6487
Mailing Address - Fax:209-835-2634
Practice Address - Street 1:436 W BEVERLY PL
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3011
Practice Address - Country:US
Practice Address - Phone:209-835-6487
Practice Address - Fax:209-835-2634
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200388882OtherTAX IDENTIFICATION NUMBER