Provider Demographics
NPI:1588877294
Name:CHARDON, ANTONIO U (DMD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:U
Last Name:CHARDON
Suffix:
Gender:M
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:VILLAS DE MONTE ATENAS 1300 CALLE ATENAS
Mailing Address - Street 2:APT. 702
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-439-1147
Mailing Address - Fax:
Practice Address - Street 1:AVE. APOLO A-2
Practice Address - Street 2:URB. ALTO APOLO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-0152
Practice Address - Fax:787-272-0150
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice