Provider Demographics
NPI:1588753305
Name:CHOI, CHARLSON (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHARLSON
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-884-2414
Mailing Address - Fax:703-651-9118
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE #218
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-884-2414
Practice Address - Fax:703-651-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13856122300000X
VA0401413283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist