Provider Demographics
NPI:1760647010
Name:WHAN MICHAEL CHO DDS PS
Entity Type:Organization
Organization Name:WHAN MICHAEL CHO DDS PS
Other - Org Name:DDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-386-9540
Mailing Address - Street 1:11605 STATE AVE
Mailing Address - Street 2:STE. 108
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8427
Mailing Address - Country:US
Mailing Address - Phone:360-386-9540
Mailing Address - Fax:360-386-9542
Practice Address - Street 1:11605 STATE AVE
Practice Address - Street 2:STE. 108
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8427
Practice Address - Country:US
Practice Address - Phone:360-386-9540
Practice Address - Fax:360-386-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00010468OtherDENTAL LISENCE
WADE00010468OtherDENTAL LISENCE