Provider Demographics
NPI:1508085960
Name:CHA, PETER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:CHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:32114 1ST AVE S
Mailing Address - Street 2:SUITE100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5760
Mailing Address - Country:US
Mailing Address - Phone:253-661-2500
Mailing Address - Fax:253-661-2505
Practice Address - Street 1:32114 1ST AVE S
Practice Address - Street 2:SUITE100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5760
Practice Address - Country:US
Practice Address - Phone:253-661-2500
Practice Address - Fax:253-661-2505
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA68481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice