Provider Demographics
NPI:1205661832
Name:LO, CHIA-TA (DDS)
Entity type:Individual
Prefix:
First Name:CHIA-TA
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NO. 201 BEIDA RD.
Mailing Address - Street 2:20F-2
Mailing Address - City:HSINCHU CITY
Mailing Address - State:TAIWAN ROC
Mailing Address - Zip Code:00000
Mailing Address - Country:TW
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 BLOOMFIELD AVE # 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1104
Practice Address - Country:US
Practice Address - Phone:973-435-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030614001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice