Provider Demographics
NPI:1912596313
Name:CHENG, ELISE MARIKO HEI-FUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARIKO HEI-FUNG
Last Name:CHENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 SADDLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2533
Mailing Address - Country:US
Mailing Address - Phone:213-986-6848
Mailing Address - Fax:
Practice Address - Street 1:3700 US HIGHWAY 98 N UNIT 105
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3863
Practice Address - Country:US
Practice Address - Phone:863-225-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN255991223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice