Provider Demographics
NPI:1932443157
Name:FENG, TINA (DDS)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:FENG
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 1:115 WHISTLESTOP WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1827
Mailing Address - Country:US
Mailing Address - Phone:972-468-1440
Mailing Address - Fax:
Practice Address - Street 1:115 WHISTLESTOP WAY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-1827
Practice Address - Country:US
Practice Address - Phone:972-468-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61836122300000X
TX29555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist