MEDICARE: GRACE T. CHU, D.M.D., P.A.

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	1223E0200X	Endodontics	22015	TX

General Provider Information

NPI Number	:	1588794283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE T. CHU, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	6009 BELT LINE RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-9126
Country	:	US
Telephone Number	:	972-385-8559
Fax Number	:	972-385-7415

Provider Business Practice Location Address
First Line	:	6009 BELT LINE RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-9126
Country	:	US
Telephone Number	:	972-385-8559
Fax Number	:	972-385-7415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GRACE TAN CHU
Credential	:	D.M.D.
Telephone Number	:	972-385-8559

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/30/2008

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