Provider Demographics
NPI:1609234178
Name:JIEUN CHOI DMD, PLLC
Entity Type:Organization
Organization Name:JIEUN CHOI DMD, PLLC
Other - Org Name:LAKESIDE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JIEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-861-0440
Mailing Address - Street 1:9202 BARKER CYPRESS RD
Mailing Address - Street 2:115
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5290
Mailing Address - Country:US
Mailing Address - Phone:281-861-0440
Mailing Address - Fax:281-861-0110
Practice Address - Street 1:9202 BARKER CYPRESS RD
Practice Address - Street 2:115
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5290
Practice Address - Country:US
Practice Address - Phone:281-861-0440
Practice Address - Fax:281-861-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053630632OtherINDIVIDUAL NPI