Provider Demographics
NPI:1952656746
Name:CHENG, MICHAEL BRYAN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRYAN
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26620 LINDENGATE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5829
Mailing Address - Country:US
Mailing Address - Phone:630-399-5506
Mailing Address - Fax:
Practice Address - Street 1:1275 BUTTERFIELD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8849
Practice Address - Country:US
Practice Address - Phone:630-653-5152
Practice Address - Fax:630-653-5380
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107331223G0001X
IL0190292461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice