Provider Demographics
NPI:1932651783
Name:JAE W. CHOI DDS PLLC
Entity Type:Organization
Organization Name:JAE W. CHOI DDS PLLC
Other - Org Name:MCLOUD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-314-0449
Mailing Address - Street 1:806 S. 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851
Mailing Address - Country:US
Mailing Address - Phone:405-395-2020
Mailing Address - Fax:405-395-2608
Practice Address - Street 1:806 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8628
Practice Address - Country:US
Practice Address - Phone:405-395-2020
Practice Address - Fax:405-395-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200585480AMedicaid
OK200551660AMedicaid