Provider Demographics
NPI:1710146154
Name:LAWRENCE M. CHENG
Entity Type:Organization
Organization Name:LAWRENCE M. CHENG
Other - Org Name:SMILE HAVEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-481-7317
Mailing Address - Street 1:10399 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6956
Mailing Address - Country:US
Mailing Address - Phone:909-481-7317
Mailing Address - Fax:909-481-7319
Practice Address - Street 1:10399 FOOTHILL BLVD
Practice Address - Street 2:SUITE 101-A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6956
Practice Address - Country:US
Practice Address - Phone:909-481-7317
Practice Address - Fax:909-481-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44577-07OtherDELTA DENTAL HEALTHY FAMILIES
1245427582OtherUNITED CONCORDIA
CA344577OtherDELTA DENTAL