Provider Demographics
NPI:1376195800
Name:ZHENG, ZHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZHI
Middle Name:
Last Name:ZHENG
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 1:1326 S WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2556
Mailing Address - Country:US
Mailing Address - Phone:224-848-2912
Mailing Address - Fax:
Practice Address - Street 1:1326 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2556
Practice Address - Country:US
Practice Address - Phone:224-848-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352891223G0001X
AR44771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILZ52098889082OtherDRIVER'S LICENSE