Provider Demographics
NPI:1568716793
Name:CHENEY, PAUL SYLVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SYLVAN
Last Name:CHENEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S. FAIRBANKS AVE.
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657
Mailing Address - Country:US
Mailing Address - Phone:559-875-5955
Mailing Address - Fax:
Practice Address - Street 1:620 S. FAIRBANKS AVE.
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657
Practice Address - Country:US
Practice Address - Phone:559-875-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA166821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice