Provider Demographics
NPI:1831279256
Name:CHOE, MIKE WANSIK (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:WANSIK
Last Name:CHOE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:265 WESTLAKE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4800
Mailing Address - Country:US
Mailing Address - Phone:910-864-2944
Mailing Address - Fax:910-864-1493
Practice Address - Street 1:265 WESTLAKE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4800
Practice Address - Country:US
Practice Address - Phone:910-864-2944
Practice Address - Fax:910-864-1493
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice