Provider Demographics
NPI:1346461977
Name:CHENG, VINCENT C (DDS MSC APC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS MSC APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 NORTH MONTEBELLO BLVD.,
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CO
Mailing Address - Zip Code:90640-3538
Mailing Address - Country:US
Mailing Address - Phone:323-728-3714
Mailing Address - Fax:323-888-6002
Practice Address - Street 1:616 NORTH MONTEBELLO BLVD.,
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CO
Practice Address - Zip Code:90640-3538
Practice Address - Country:US
Practice Address - Phone:323-728-3714
Practice Address - Fax:323-888-6002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93726-01Medicare ID - Type UnspecifiedGENERAL DENTISTRY