Provider Demographics
NPI:1184849192
Name:CHOI, SEONG
Entity type:Individual
Prefix:
First Name:SEONG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17002 E MAINSTREET STE H
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4961
Mailing Address - Country:US
Mailing Address - Phone:720-213-0004
Mailing Address - Fax:
Practice Address - Street 1:17002 E MAINSTREET
Practice Address - Street 2:UNIT H
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4961
Practice Address - Country:US
Practice Address - Phone:720-842-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92701223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice