Provider Demographics
NPI:1710441092
Name:EDWIN CHICCHON DDS INC
Entity Type:Organization
Organization Name:EDWIN CHICCHON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICCHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-713-8986
Mailing Address - Street 1:3200 MOWRY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1510
Mailing Address - Country:US
Mailing Address - Phone:510-713-8986
Mailing Address - Fax:510-713-8068
Practice Address - Street 1:3200 MOWRY AVE STE D
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1510
Practice Address - Country:US
Practice Address - Phone:510-713-8986
Practice Address - Fax:510-713-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental