Provider Demographics
NPI:1144804097
Name:CHACKO, ASHLEY (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 VICTORS CHASE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5726
Mailing Address - Country:US
Mailing Address - Phone:832-465-7818
Mailing Address - Fax:
Practice Address - Street 1:2909 HILLCROFT ST # A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5847
Practice Address - Country:US
Practice Address - Phone:713-706-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368531223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice