Guillermo Enrique Chacon, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE 60063175 Issued in WA

Practice address

2910 S Meridian
Suite 120
Puyallup, WA 98373-1585

Phone

(253) 445-0022

Fax

(253) 445-0979

NPI assigned

Nov 8, 2006

Last updated

Apr 10, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 17, 2020 through Sep 17, 2026

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Guillermo E Chacon, DDS, PS

  dba Oral & Facial Surgery Centers of Washington

  • Oral and Maxillofacial Surgery (Dentist)
  • Puyallup, WA
  • NPI 1942820626
  NPD (past) Authorized official
• Oral and Facial Surgeons of Ohio

  • Oral and Maxillofacial Surgery (Dentist)
  • Dublin, OH
  • NPI 1043427883
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1619047511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 S MERIDIAN",
            "address_2": "SUITE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983731585",
            "telephone_number": "253-445-0022",
            "fax_number": "253-445-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 S MERIDIAN",
            "address_2": "SUITE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983731585",
            "telephone_number": "253-445-0022",
            "fax_number": "253-445-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACON",
        "first_name": "GUILLERMO",
        "middle_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE 60063175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "2237985",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED PROVIDER",
            "identifier": "CH4046621",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2237985",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "311203750028",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Edward Cerka, MA
• Stephanie Cervantes Figueroa
• Tiffany Cha, OTD, OTR/L
• Allen Rajan Chacko, DO
• Jebin Mathew Chacko, MD
• Jessaryn Chahalis, CPO
• Darick Gongqing Chai
• Kyle Richard Chambers
• Ryan Justin Chambers
• Chan S Hwang, MD, PLLC

• Oral and Maxillofacial Surgery (Dentist) in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.