Provider Demographics
NPI:1740431543
Name:CHACKO, CYNTHIA (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
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 1:31 SE 24TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5347
Mailing Address - Country:US
Mailing Address - Phone:813-453-0677
Mailing Address - Fax:
Practice Address - Street 1:31 SE 24TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5347
Practice Address - Country:US
Practice Address - Phone:813-453-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist