MEDICARE: DR. REGINA CHOI D.D.S.

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	22DI02278000	NJ

General Provider Information

NPI Number	:	1386653715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA CHOI D.D.S.

Provider Business Mailing Address
First Line	:	110 BROAD AVE
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-2003
Country	:	US
Telephone Number	:	201-346-9991
Fax Number	:	201-346-9993

Provider Business Practice Location Address
First Line	:	110 BROAD AVE
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-2003
Country	:	US
Telephone Number	:	201-346-9991
Fax Number	:	201-346-9993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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