Healthcare Provider Details

I. General information

NPI: 1487599882
Provider Name (Legal Business Name): ANDREW TALABON CHUA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 BOSTON RD
JOINT BASE ANDREWS MD
20762
US

IV. Provider business mailing address

100 TIFFANY LN
EGG HARBOR TOWNSHIP NJ
08234-4304
US

V. Phone/Fax

Practice location:
  • Phone: 609-389-2108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18804
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03163300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: