Provider Demographics
NPI:1245436237
Name:MIKE W CHOE DDS PA
Entity type:Organization
Organization Name:MIKE W CHOE DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:WANSIK
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:910-864-2944
Mailing Address - Street 1:265 WESTLAKE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4800
Mailing Address - Country:US
Mailing Address - Phone:910-864-2944
Mailing Address - Fax:910-864-1493
Practice Address - Street 1:265 WESTLAKE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4800
Practice Address - Country:US
Practice Address - Phone:910-864-2944
Practice Address - Fax:910-864-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX IDENTIFICATION NUMBER