Provider Demographics
NPI:1669475406
Name:CHENG, THERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
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 1:22516 SE 64TH PLACE
Mailing Address - Street 2:#250
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-392-8992
Mailing Address - Fax:425-392-0184
Practice Address - Street 1:22516 SE 64TH PLACE
Practice Address - Street 2:#250
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-392-8992
Practice Address - Fax:425-392-0184
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60841223P0300X
WADE000060841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics