Provider Demographics
NPI:1457710717
Name:CHUN W. PENG DMD, PLLC
Entity Type:Organization
Organization Name:CHUN W. PENG DMD, PLLC
Other - Org Name:MOORES CHAPEL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN
Authorized Official - Middle Name:WEI
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-398-9299
Mailing Address - Street 1:9115 SAMLEN LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-3360
Mailing Address - Country:US
Mailing Address - Phone:704-398-9299
Mailing Address - Fax:
Practice Address - Street 1:9115 SAMLEN LN
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-3360
Practice Address - Country:US
Practice Address - Phone:704-398-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty