Provider Demographics
NPI:1730924473
Name:CHACON, JESSICA PATRICIA (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PATRICIA
Last Name:CHACON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VILLAGE DR APT 447
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3390
Mailing Address - Country:US
Mailing Address - Phone:201-744-0891
Mailing Address - Fax:
Practice Address - Street 1:1710 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3352
Practice Address - Country:US
Practice Address - Phone:610-277-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0447061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice