MEDICARE: DR. CASEY CHOW D.M.D.

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	6317	NV

General Provider Information

NPI Number	:	1992051403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY CHOW D.M.D.

Provider Business Mailing Address
First Line	:	7821 TENSHAW AVE
Second Line	:	#203
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-2998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 W CRAIG RD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6018
Country	:	US
Telephone Number	:	702-464-3090
Fax Number	:	702-464-3158

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

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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