Provider Demographics
NPI:1902897283
Name:CHAO, ALEXANDER L (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:L
Last Name:CHAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9424 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2028
Mailing Address - Country:US
Mailing Address - Phone:718-275-4945
Mailing Address - Fax:718-897-9060
Practice Address - Street 1:9424 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2028
Practice Address - Country:US
Practice Address - Phone:718-275-4945
Practice Address - Fax:718-897-9060
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02280197Medicaid