Provider Demographics
NPI:1720522360
Name:CHENG SHAO ANWAR PLLC
Entity Type:Organization
Organization Name:CHENG SHAO ANWAR PLLC
Other - Org Name:FRESH SMILES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-212-4925
Mailing Address - Street 1:27041 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-9250
Mailing Address - Country:US
Mailing Address - Phone:206-212-4925
Mailing Address - Fax:
Practice Address - Street 1:27041 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-9250
Practice Address - Country:US
Practice Address - Phone:206-212-4925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE110051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty