Healthcare Provider Details

I. General information

NPI: 1396791489
Provider Name (Legal Business Name): STANLEY CHO DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 M ST NE
AUBURN WA
98002-4501
US

IV. Provider business mailing address

620 M ST NE
AUBURN WA
98002-4501
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-9062
  • Fax: 253-351-0503
Mailing address:
  • Phone: 253-833-9062
  • Fax: 253-351-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00003554
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00003871
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00006154
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00005696
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007992
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006607
License Number StateWA
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007968
License Number StateWA

VIII. Authorized Official

Name: KELLY DIXON
Title or Position: OFFICE MANAGER
Credential:
Phone: 253-833-9062