Provider Demographics
NPI:1942820626
Name:GUILLERMO E CHACON, DDS, PS
Entity Type:Organization
Organization Name:GUILLERMO E CHACON, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-445-0022
Mailing Address - Street 1:2910 S MERIDIAN STE 120
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1585
Mailing Address - Country:US
Mailing Address - Phone:253-445-0022
Mailing Address - Fax:253-445-0979
Practice Address - Street 1:2910 S MERIDIAN STE 120
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1585
Practice Address - Country:US
Practice Address - Phone:253-445-0022
Practice Address - Fax:253-445-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty