Provider Demographics
NPI:1689553950
Name:MCMINNVILLE PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:MCMINNVILLE PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHEOL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-607-3940
Mailing Address - Street 1:1605 OAK ST SE APT A208
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-4703
Mailing Address - Country:US
Mailing Address - Phone:919-607-3940
Mailing Address - Fax:
Practice Address - Street 1:2240 SW 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5583
Practice Address - Country:US
Practice Address - Phone:503-583-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental