Provider Demographics
NPI:1952548422
Name:CHAMORRO, JORGE ADALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ADALBERTO
Last Name:CHAMORRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 OLD KINGS RD S STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4845
Mailing Address - Country:US
Mailing Address - Phone:904-731-3889
Mailing Address - Fax:904-731-3912
Practice Address - Street 1:8613 OLD KINGS RD S STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4845
Practice Address - Country:US
Practice Address - Phone:904-731-3889
Practice Address - Fax:904-731-3912
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL.DN 0012620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist