Provider Demographics
NPI:1265773782
Name:CENTRAL VALLEY DENTISTRY
Entity type:Organization
Organization Name:CENTRAL VALLEY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-246-0385
Mailing Address - Street 1:6232 N 7TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1839
Mailing Address - Country:US
Mailing Address - Phone:602-246-0385
Mailing Address - Fax:602-393-1023
Practice Address - Street 1:6232 N 7TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1839
Practice Address - Country:US
Practice Address - Phone:602-246-0385
Practice Address - Fax:602-393-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty