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General NPI Number Information
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NPI Number | 1578968541
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Entity Type | Organization
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Legal Business Name | CHOICE FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 10570 FOOTHILL BLVD STE. 240
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3876
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Country | US
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Telephone | 909-948-2000
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Fax | 909-948-2003
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Provider Business Mailing Address
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Address Line | 10570 FOOTHILL BLVD STE. 240
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3876
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Country | US
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Telephone | 909-948-2000
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Fax | 909-948-2003
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA K. CHOI
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Credential | D.D.S.
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Telephone | 909-948-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 64029
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41715
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License Number State | CA
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