Provider Demographics
NPI:1093820672
Name:CHENG, PAMELA W (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:W
Last Name:CHENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 BROADWAY
Mailing Address - Street 2:3T
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2164
Mailing Address - Country:US
Mailing Address - Phone:718-397-5948
Mailing Address - Fax:
Practice Address - Street 1:5840 GRANGER ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3930
Practice Address - Country:US
Practice Address - Phone:718-271-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0394731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice