Provider Demographics
NPI:1952788267
Name:CHO, CASEY (DDS)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CHO
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 1:375 KELSEY LN STE 1
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6480
Mailing Address - Country:US
Mailing Address - Phone:615-972-0106
Mailing Address - Fax:
Practice Address - Street 1:375 KELSEY LN STE 1
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6480
Practice Address - Country:US
Practice Address - Phone:828-276-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice