Provider Demographics
NPI:1588016497
Name:CHOI, SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
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 1:4012 165TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2622
Mailing Address - Country:US
Mailing Address - Phone:917-843-8282
Mailing Address - Fax:
Practice Address - Street 1:56 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2961
Practice Address - Country:US
Practice Address - Phone:203-463-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice