Provider Demographics
NPI:1023867264
Name:CHENG, JACKEY (DMD)
Entity type:Individual
Prefix:DR
First Name:JACKEY
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MIDDLEFIELD RD
Mailing Address - Street 2:UNIT 105
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ON
Mailing Address - Zip Code:M1V5H5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 MIDDLEFIELD RD
Practice Address - Street 2:UNIT 105
Practice Address - City:SCARBOROUGH
Practice Address - State:ON
Practice Address - Zip Code:M1V5H5
Practice Address - Country:CA
Practice Address - Phone:267-223-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE15426881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty