Provider Demographics
NPI:1548341985
Name:CHOI, DANIEL J (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CHOI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1119
Mailing Address - Country:US
Mailing Address - Phone:360-438-8299
Mailing Address - Fax:
Practice Address - Street 1:727 N 182ND ST # 201
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-546-2424
Practice Address - Fax:206-546-2425
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051339Medicaid
WA4408CHOtherREGENCE BLUE SHIELD