MEDICARE: MIKE W CHOE DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6412	NC

General Provider Information

NPI Number	:	1245436237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKE W CHOE DDS PA

Provider Business Mailing Address
First Line	:	265 WESTLAKE RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-4800
Country	:	US
Telephone Number	:	910-864-2944
Fax Number	:	910-864-1493

Provider Business Practice Location Address
First Line	:	265 WESTLAKE RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-4800
Country	:	US
Telephone Number	:	910-864-2944
Fax Number	:	910-864-1493

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIKE WANSIK CHOE
Credential	:	DDS PA
Telephone Number	:	910-864-2944

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	04/21/2016

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