Provider Demographics
NPI:1326119876
Name:FENG, FRANK TY (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:TY
Last Name:FENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2340
Mailing Address - Country:US
Mailing Address - Phone:847-256-0905
Mailing Address - Fax:
Practice Address - Street 1:4108 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2007
Practice Address - Country:US
Practice Address - Phone:773-549-6116
Practice Address - Fax:773-549-8109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice