Provider Demographics
NPI:1679817845
Name:CHEUNG, SHIRLEY GARMIN (DMD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:GARMIN
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9724
Mailing Address - Country:US
Mailing Address - Phone:718-954-6507
Mailing Address - Fax:
Practice Address - Street 1:565 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9724
Practice Address - Country:US
Practice Address - Phone:718-954-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist