Provider Demographics
NPI:1205277118
Name:CHO, DANIEL J (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11786 SW BARNES RD STE 340
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5930
Mailing Address - Country:US
Mailing Address - Phone:503-646-4600
Mailing Address - Fax:971-317-8466
Practice Address - Street 1:11786 SW BARNES RD STE 340
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5930
Practice Address - Country:US
Practice Address - Phone:503-646-4600
Practice Address - Fax:971-317-8466
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD108031223G0001X
VT016.00968681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice