Healthcare Provider Details

I. General information

NPI: 1184637555
Provider Name (Legal Business Name): CHIH FENG JOHN FANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 SE 17TH ST
OCALA FL
34471-5516
US

IV. Provider business mailing address

2843 SE 17TH ST
OCALA FL
34471-5516
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5555
  • Fax:
Mailing address:
  • Phone: 352-732-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: