Provider Demographics
NPI:1255591897
Name:CHORAK, MARIO D (DMD, PS)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:D
Last Name:CHORAK
Suffix:
Gender:M
Credentials:DMD, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 SE PETROVITSKY RD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8955
Mailing Address - Country:US
Mailing Address - Phone:425-235-8800
Mailing Address - Fax:425-235-0288
Practice Address - Street 1:14300 SE PETROVITSKY RD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8955
Practice Address - Country:US
Practice Address - Phone:425-235-8800
Practice Address - Fax:425-235-0288
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics