Provider Demographics
NPI:1184063109
Name:PO-CHENG TSAI DMD, LLC
Entity type:Organization
Organization Name:PO-CHENG TSAI DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PO- CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-321-7715
Mailing Address - Street 1:10 FAIRWAY DR
Mailing Address - Street 2:PO BOX 219
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1500
Mailing Address - Country:US
Mailing Address - Phone:860-464-8352
Mailing Address - Fax:860-464-8686
Practice Address - Street 1:10 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1500
Practice Address - Country:US
Practice Address - Phone:860-464-8352
Practice Address - Fax:860-464-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty