Reny Chacko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS58470 Issued in CA

Practice address

709 Center Dr Ste 101
San Marcos, CA 92069-2502

Phone

(760) 746-2045

NPI assigned

Jan 18, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nosti and Reagan Dental Corporation

  • General Practice Dentistry
  • San Marcos, CA
  • NPI 1699874925
  NPD (past)
• Dental Services Inc

  • General Practice Dentistry
  • Big Lake, MN
  • NPI 1013069012
  NPD (past)
• Modern Dental Professionals MN PC

  • General Practice Dentistry
  • Big Lake, MN
  • NPI 1215307061
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1013069996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 CENTER DR STE 101",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692502",
            "telephone_number": "760-746-2045",
            "fax_number": "763-263-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 CENTER DR STE 101",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692502",
            "telephone_number": "760-746-2045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "195 Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Big Lake",
            "state": "MN",
            "postal_code": "553099572",
            "country_code": "US",
            "telephone_number": "763-263-2222",
            "fax_number": "763-263-5822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "RENY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS58470",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS58470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Celeste
• Mary Ding Cen, L.AC. LICENSED ACUPU
• Ethelaine Centeno, OTR
• Cep America - Psychiatry PC
• Christina Rose Cesare
• Juan Chacon Vargas
• Stephanie Chacon
• Chad Pexton DDS PC
• Sarvenaz Chaichian, DMD
• Carolyn Jessica Chan, DPT

• General Practice Dentistry in San Marcos, CA
• Providers in San Marcos, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.