Provider Demographics
NPI:1548521065
Name:CHENG YEN DMD PLLC
Entity type:Organization
Organization Name:CHENG YEN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-857-1111
Mailing Address - Street 1:1475 GEORGE DIETER DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7677
Mailing Address - Country:US
Mailing Address - Phone:915-857-1111
Mailing Address - Fax:915-857-1212
Practice Address - Street 1:1475 GEORGE DIETER DR
Practice Address - Street 2:SUITE L
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7677
Practice Address - Country:US
Practice Address - Phone:915-857-1111
Practice Address - Fax:915-857-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248651223P0221X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty