Provider Demographics
NPI:1942322870
Name:ABY JACOB CHACKO, D.M.D., P.A.
Entity Type:Organization
Organization Name:ABY JACOB CHACKO, D.M.D., P.A.
Other - Org Name:PREMIER DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-530-3644
Mailing Address - Street 1:1417 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-6037
Mailing Address - Country:US
Mailing Address - Phone:972-530-3644
Mailing Address - Fax:972-530-3655
Practice Address - Street 1:6504 HIGHWAY 78
Practice Address - Street 2:SUITE 146
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3259
Practice Address - Country:US
Practice Address - Phone:972-530-3644
Practice Address - Fax:972-530-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty