Provider Demographics
NPI:1679709745
Name:CHO, TINA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:K
Last Name:CHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OMNI CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5211
Mailing Address - Country:US
Mailing Address - Phone:201-486-8421
Mailing Address - Fax:
Practice Address - Street 1:2 OMNI CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5211
Practice Address - Country:US
Practice Address - Phone:845-634-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023985001223G0001X
NY0559521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice