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Contact Information

RENY CHACKO, DDS
195 JEFFERSON BLVD
BIG LAKE, MN55309-9572
 Phone: 763-263-2222
 Fax: 763-263-5822
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for RENY CHACKO · (Female)

NPI Number 1013069996
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 01/18/2007
Last updated 07/08/2007 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • MN License # D11844
  • MN Other 100132900 MEDICAL ASSISTANCE NUMBER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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