Provider Demographics
NPI:1437272192
Name:CHUA, MARK N (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:CHUA
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 1:21 KING'S CROSSING #107
Mailing Address - Street 2:PO BOX 1266
Mailing Address - City:WINTER PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80482-1266
Mailing Address - Country:US
Mailing Address - Phone:970-726-5556
Mailing Address - Fax:970-726-4732
Practice Address - Street 1:21 KING'S CROSSING #107
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-1266
Practice Address - Country:US
Practice Address - Phone:970-726-5556
Practice Address - Fax:970-726-4732
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist