Provider Demographics
NPI:1972777993
Name:CHU, JOLIE (DDS)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MY DUNG
Other - Middle Name:T
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:10311 N ELDRIDGE PKWY
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5368
Mailing Address - Country:US
Mailing Address - Phone:281-897-9977
Mailing Address - Fax:
Practice Address - Street 1:10311 N ELDRIDGE PKWY
Practice Address - Street 2:SUITE B-7
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5368
Practice Address - Country:US
Practice Address - Phone:281-897-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190233001Medicaid