MEDICARE: VANESSA CHOY 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	122300000X	Dentist	DN1855059	MA
2	122300000X	Dentist	57244	CA

General Provider Information

NPI Number	:	1790932408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA CHOY D.D.S.

Provider Business Mailing Address
First Line	:	430 W ERIE ST STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-6920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 STAFFORD ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1450
Country	:	US
Telephone Number	:	508-770-0900
Fax Number	:

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	05/13/2009

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