Provider Demographics
NPI:1396791489
Name:STANLEY CHO DDS PLLC
Entity type:Organization
Organization Name:STANLEY CHO DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-833-9062
Mailing Address - Street 1:620 M ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4501
Mailing Address - Country:US
Mailing Address - Phone:253-833-9062
Mailing Address - Fax:253-351-0503
Practice Address - Street 1:620 M ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4501
Practice Address - Country:US
Practice Address - Phone:253-833-9062
Practice Address - Fax:253-351-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000035541223G0001X
WADE000038711223X0400X
WADE000061541223P0300X
WADE000056961223G0001X
WADE000079921223G0001X
WADE000066071223G0001X
WADE000079681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty