Provider Demographics
NPI:1568605715
Name:CHENG, ALICE (DDS)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SOUTH ST UNIT 42
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2707
Mailing Address - Country:US
Mailing Address - Phone:917-373-3686
Mailing Address - Fax:
Practice Address - Street 1:210 SOUTH ST UNIT 42
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2707
Practice Address - Country:US
Practice Address - Phone:917-373-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist