MEDICARE: CHOI DENTISTRY PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1780210377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOI DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	3057 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3763
Country	:	US
Telephone Number	:	702-369-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3763
Country	:	US
Telephone Number	:	702-369-8730
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HANTAE CHOI
Credential	:	DDS
Telephone Number	:	702-369-8730

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	10/06/2020

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