Provider Demographics
NPI:1508004961
Name:CHACKO, DANNY (DMD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S THOMPSON ST
Mailing Address - Street 2:P O BOX 5265
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-2310
Mailing Address - Country:US
Mailing Address - Phone:423-569-6414
Mailing Address - Fax:
Practice Address - Street 1:117 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2310
Practice Address - Country:US
Practice Address - Phone:423-569-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS004277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist