Healthcare Provider Details

I. General information

NPI: 1164252250
Provider Name (Legal Business Name): CAROLINE MAN GEE CHEUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

3820 CONCORD CRT
WINDSOR ONTARIO
N9G 3B3
CA

V. Phone/Fax

Practice location:
  • Phone: 313-494-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2952000853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: