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General NPI Number Information
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NPI Number | 1801876842
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Entity Type | Individual
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Provider Name | MARK T CHAO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 3031 W MARCH LN SUITE #340
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City | STOCKTON
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State | CA
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Zip | 95219-6500
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Country | US
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Telephone | 209-369-3617
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Fax | 209-369-0498
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Provider Business Mailing Address
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Address Line | 3031 W MARCH LN SUITE #340
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City | STOCKTON
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State | CA
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Zip | 95219-6500
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Country | US
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Telephone | 209-369-3617
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Fax | 209-369-0498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56858
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License Number State | CA
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