Provider Demographics
NPI:1447092580
Name:LO, CHELSIE (DMD)
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 W ECHO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4285
Mailing Address - Country:US
Mailing Address - Phone:510-283-8659
Mailing Address - Fax:
Practice Address - Street 1:25155 N 67TH AVE STE 142
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1065
Practice Address - Country:US
Practice Address - Phone:623-561-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0121971223G0001X, 122300000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program