=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770084055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOY ORTHO-PEDO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2018
-----------------------------------------------------
Last Update Date | 02/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 SOUTH ANGEL PARKWAY SUITE 400
-----------------------------------------------------
City | LUCAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-646-7774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 SUMMIT AVE UNIT 1
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-8565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-699-4109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL CHOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-699-4109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------