Provider Demographics
NPI:1518724053
Name:CHOI DMD AND CHOI DDS LLC
Entity Type:Organization
Organization Name:CHOI DMD AND CHOI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-639-4330
Mailing Address - Street 1:14300 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3790
Mailing Address - Country:US
Mailing Address - Phone:503-639-4330
Mailing Address - Fax:503-639-5400
Practice Address - Street 1:18425 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-3932
Practice Address - Country:US
Practice Address - Phone:503-259-8641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty