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General NPI Number Information
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NPI Number | 1932651783
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Entity Type | Organization
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Legal Business Name | JAE W. CHOI DDS PLLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 806 S 8TH ST
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City | MCLOUD
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State | OK
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Zip | 74851-8628
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Country | US
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Telephone | 405-395-2020
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Fax | 405-395-2608
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Provider Business Mailing Address
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Address Line | 806 S. 8TH ST.
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City | MCLOUD
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State | OK
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Zip | 74851
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Country | US
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Telephone | 405-395-2020
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Fax | 405-395-2608
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JAE WOO CHOI
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Credential | D.D.S
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Telephone | 405-314-0449
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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 | 6704
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License Number State | OK
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