Healthcare Provider Details

I. General information

NPI: 1922678739
Provider Name (Legal Business Name): ANDY CHEUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEACH ST
BOSTON MA
02111-2511
US

IV. Provider business mailing address

82 WENDELL AVE STE 100
PITTSFIELD MA
01201-7066
US

V. Phone/Fax

Practice location:
  • Phone: 617-542-6263
  • Fax:
Mailing address:
  • Phone: 617-798-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDN10000108
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10000108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: