=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992558894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENA S. CHO DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2024
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 PIDGEON HILL DR STE 207
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20165-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 793-444-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 PIDGEON HILL DR STE 207
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20165-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 793-444-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. SERENA CHO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 443-834-5652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------