Provider Demographics
NPI:1780745000
Name:CHEW, ROLAND G (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:G
Last Name:CHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:39055 HASTINGS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1518
Mailing Address - Country:US
Mailing Address - Phone:510-793-0300
Mailing Address - Fax:510-793-0301
Practice Address - Street 1:39055 HASTINGS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1518
Practice Address - Country:US
Practice Address - Phone:510-793-0300
Practice Address - Fax:510-793-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA411691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41169OtherSTATE LICENSE