MEDICARE: DR. MARK T CHAO 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	56858	CA

General Provider Information

NPI Number	:	1801876842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK T CHAO D.D.S.

Provider Business Mailing Address
First Line	:	3031 W MARCH LN
Second Line	:	SUITE #340
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-369-3617
Fax Number	:	209-369-0498

Provider Business Practice Location Address
First Line	:	3031 W MARCH LN
Second Line	:	SUITE #340
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-369-3617
Fax Number	:	209-369-0498

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/03/2014

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