Provider Demographics
NPI:1306825542
Name:CHOI, JONG RYUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:RYUL
Last Name:CHOI
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 1:4927 RAVINE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9442
Mailing Address - Country:US
Mailing Address - Phone:734-355-0737
Mailing Address - Fax:734-572-4497
Practice Address - Street 1:4660 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1309
Practice Address - Country:US
Practice Address - Phone:734-355-0737
Practice Address - Fax:734-572-4497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice