Provider Demographics
NPI:1306007703
Name:CHENG, EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
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 1:5802 WASHINGTON AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4050
Mailing Address - Country:US
Mailing Address - Phone:262-886-1957
Mailing Address - Fax:
Practice Address - Street 1:5802 WASHINGTON AVE
Practice Address - Street 2:STE 202
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4050
Practice Address - Country:US
Practice Address - Phone:262-886-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027647122300000X
WI6276-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist