Provider Demographics
NPI:1174154058
Name:CHONG DENTAL & ASSOCIATES
Entity type:Organization
Organization Name:CHONG DENTAL & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-680-9961
Mailing Address - Street 1:670 W ARAPAHO RD STE 13
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4213
Mailing Address - Country:US
Mailing Address - Phone:972-669-0409
Mailing Address - Fax:
Practice Address - Street 1:670 W ARAPAHO RD STE 13
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4213
Practice Address - Country:US
Practice Address - Phone:972-669-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty