Provider Demographics
NPI:1619546272
Name:CHACHO, MICHAEL BRADLEY (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:CHACHO
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 1:1252 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1385
Mailing Address - Country:US
Mailing Address - Phone:303-915-5552
Mailing Address - Fax:
Practice Address - Street 1:10650 GARDEN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-7018
Practice Address - Country:US
Practice Address - Phone:303-366-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002047791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty