Provider Demographics
NPI:1245427582
Name:CHENG, LAWRENCE MIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MIN
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10399 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6956
Mailing Address - Country:US
Mailing Address - Phone:909-481-7317
Mailing Address - Fax:909-481-7319
Practice Address - Street 1:10399 FOOTHILL BLVD
Practice Address - Street 2:SUITE 101-A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6956
Practice Address - Country:US
Practice Address - Phone:909-481-7317
Practice Address - Fax:909-481-7319
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist