Provider Demographics
NPI:1518085836
Name:CHACON, ROBERT A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:CHACON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6129 DUBLIN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7567
Mailing Address - Country:US
Mailing Address - Phone:925-833-9643
Mailing Address - Fax:925-833-0764
Practice Address - Street 1:6129 DUBLIN BLVD STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7567
Practice Address - Country:US
Practice Address - Phone:925-833-9643
Practice Address - Fax:925-833-0764
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA337331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice