Provider Demographics
NPI:1952293870
Name:CHACON ORTHODONTICS PLLC
Entity type:Organization
Organization Name:CHACON ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-929-6486
Mailing Address - Street 1:13019 W LINEBAUGH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTCHASE
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4507
Mailing Address - Country:US
Mailing Address - Phone:786-929-6486
Mailing Address - Fax:
Practice Address - Street 1:510 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5316
Practice Address - Country:US
Practice Address - Phone:786-929-6486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty