Provider Demographics
NPI:1639695075
Name:HEO, CHUNG ROK (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:ROK
Last Name:HEO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6523 ESCENA BLVD UNIT 3100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4280
Mailing Address - Country:US
Mailing Address - Phone:407-388-8678
Mailing Address - Fax:
Practice Address - Street 1:3940 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3468
Practice Address - Country:US
Practice Address - Phone:972-227-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice