1487695094 NPI number — DR. MICHAEL M CHENG D.D.S., PC

Table of content: DR. MICHAEL M CHENG D.D.S., PC (NPI 1487695094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487695094 NPI number — DR. MICHAEL M CHENG D.D.S., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENG
Provider First Name:
MICHAEL
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., PC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487695094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-330-2123
Provider Business Mailing Address Fax Number:
405-285-4695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-330-2123
Provider Business Practice Location Address Fax Number:
405-285-4695
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5600 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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