Provider Demographics
NPI:1891836987
Name:DR. W. DEAN CHOW
Entity Type:Organization
Organization Name:DR. W. DEAN CHOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:662-328-5411
Mailing Address - Street 1:1821 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2203
Mailing Address - Country:US
Mailing Address - Phone:662-328-5411
Mailing Address - Fax:662-328-1775
Practice Address - Street 1:1821 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2203
Practice Address - Country:US
Practice Address - Phone:662-328-5411
Practice Address - Fax:662-328-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA249023Medicare UPIN
AL11034Medicare UPIN
000800596Medicare UPIN