Provider Demographics
NPI:1235567173
Name:CHO, JEONG RAE (DDS)
Entity Type:Individual
Prefix:
First Name:JEONG RAE
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3775
Mailing Address - Country:US
Mailing Address - Phone:203-889-2611
Mailing Address - Fax:
Practice Address - Street 1:666 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3775
Practice Address - Country:US
Practice Address - Phone:203-889-2611
Practice Address - Fax:203-823-9072
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics