MEDICARE: CHENG YEN DMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	24865	TX
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1548521065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHENG YEN DMD PLLC

Provider Business Mailing Address
First Line	:	1475 GEORGE DIETER DR
Second Line	:	SUITE L
City	:	EL PASO
State	:	TX
Zip	:	79936-7677
Country	:	US
Telephone Number	:	915-857-1111
Fax Number	:	915-857-1212

Provider Business Practice Location Address
First Line	:	1475 GEORGE DIETER DR
Second Line	:	SUITE L
City	:	EL PASO
State	:	TX
Zip	:	79936-7677
Country	:	US
Telephone Number	:	915-857-1111
Fax Number	:	915-857-1212

Authorized Official
Title or Position	:	OWNER
Name	:	CHENG YEN
Credential	:	DMD
Telephone Number	:	915-857-1111

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	09/19/2012

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Directions to “CHENG YEN DMD PLLC ” Practice Location

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