Provider Demographics
NPI:1124504188
Name:CHAO, JIREH JR
Entity type:Individual
Prefix:
First Name:JIREH
Middle Name:
Last Name:CHAO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 MASTERSON CT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1445
Mailing Address - Country:US
Mailing Address - Phone:609-870-3308
Mailing Address - Fax:
Practice Address - Street 1:338 GEORGES RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1546
Practice Address - Country:US
Practice Address - Phone:732-329-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI027249001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice