Provider Demographics
NPI:1336359231
Name:CHA, AUDREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 EASTLAWN DR.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229
Mailing Address - Country:US
Mailing Address - Phone:214-496-0606
Mailing Address - Fax:
Practice Address - Street 1:209 S O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2950
Practice Address - Country:US
Practice Address - Phone:972-251-1701
Practice Address - Fax:972-254-1189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist