Provider Demographics
NPI:1629297908
Name:CHO, MINSOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINSOO
Middle Name:
Last Name:CHO
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 1:8601 JUSTICE AVE
Mailing Address - Street 2:NEWTOWN SMILE DENTAL
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4555
Mailing Address - Country:US
Mailing Address - Phone:718-393-0100
Mailing Address - Fax:718-889-2355
Practice Address - Street 1:8601 JUSTICE AVE
Practice Address - Street 2:NEWTOWN SMILE DENTAL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4555
Practice Address - Country:US
Practice Address - Phone:718-393-0100
Practice Address - Fax:718-889-2355
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist