Provider Demographics
NPI:1952592032
Name:CHOE, MARK C (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:CHOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9528 FAIRFAX BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4738
Mailing Address - Country:US
Mailing Address - Phone:703-279-3400
Mailing Address - Fax:703-766-1374
Practice Address - Street 1:9528 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4738
Practice Address - Country:US
Practice Address - Phone:703-279-3400
Practice Address - Fax:703-766-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice