Provider Demographics
NPI:1578968541
Name:CHOICE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CHOICE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-948-2000
Mailing Address - Street 1:10570 FOOTHILL BLVD
Mailing Address - Street 2:STE. 240
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3876
Mailing Address - Country:US
Mailing Address - Phone:909-948-2000
Mailing Address - Fax:909-948-2003
Practice Address - Street 1:10570 FOOTHILL BLVD
Practice Address - Street 2:STE. 240
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3876
Practice Address - Country:US
Practice Address - Phone:909-948-2000
Practice Address - Fax:909-948-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41715122300000X
CA64029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty