Individual
CHELSIE LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
25155 N 67TH AVE STE 142, PHOENIX, AZ 85083-1065
(623) 561-6767
Mailing address
2269 W ECHO LN, PHOENIX, AZ 85021-4285
(510) 283-8659
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D012197
AZ
1223G0001X
General Practice Dentistry
D012197
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
AZ
Other
Enumeration date
06/10/2024
Last updated
06/12/2024
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