Provider Demographics
NPI:1477915965
Name:CHENG, WILFRED (DMD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:CHENG
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 1:233 E SHORE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2433
Mailing Address - Country:US
Mailing Address - Phone:516-466-1070
Mailing Address - Fax:
Practice Address - Street 1:233 E SHORE RD STE 104
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-466-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2023-08-16
Deactivation Date:2016-10-31
Deactivation Code:
Reactivation Date:2016-11-16
Provider Licenses
StateLicense IDTaxonomies
NY062268-011223P0300X
PADS0414171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics