Provider Demographics
NPI:1285964965
Name:CHO, ANDREW (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CONSHOHOCKEN AVE
Mailing Address - Street 2:APT. 1009
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 CONSHOHOCKEN AVE
Practice Address - Street 2:APT. 1009
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5539
Practice Address - Country:US
Practice Address - Phone:215-806-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist