Provider Demographics
NPI:1902923485
Name:JOO, CHUCK C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUCK
Middle Name:C
Last Name:JOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:FAIR OAKS
Other - Middle Name:DENTAL
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-766-1575
Mailing Address - Fax:
Practice Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3310
Practice Address - Country:US
Practice Address - Phone:703-766-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist