Provider Demographics
NPI:1356767701
Name:CHENG YEN DMD
Entity type:Organization
Organization Name:CHENG YEN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-857-1111
Mailing Address - Street 1:1475 GEORGE DIETER DR STE L1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7634
Mailing Address - Country:US
Mailing Address - Phone:915-857-1111
Mailing Address - Fax:915-857-1212
Practice Address - Street 1:1475 GEORGE DIETER DR STE L1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7634
Practice Address - Country:US
Practice Address - Phone:915-857-1111
Practice Address - Fax:915-857-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty