MEDICARE: CASEY CHO 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	10212	TN

General Provider Information

NPI Number	:	1952788267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY CHO D.D.S

Provider Business Mailing Address
First Line	:	375 KELSEY LN STE 1
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6480
Country	:	US
Telephone Number	:	615-972-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 KELSEY LN STE 1
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6480
Country	:	US
Telephone Number	:	828-276-3367
Fax Number	:

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	03/14/2019

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Directions to “ CASEY CHO D.D.S” Practice Location

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