Provider Demographics
NPI:1770855876
Name:CHOI PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHOI PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CHOICE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-940-5771
Mailing Address - Street 1:1688 N PERRIS BLVD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4709
Mailing Address - Country:US
Mailing Address - Phone:951-940-5771
Mailing Address - Fax:951-940-5773
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:SUITE G1
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-940-5771
Practice Address - Fax:951-940-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41715122300000X
CA54567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty