=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265104384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT CHENG DENTAL CORPOATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2021
-----------------------------------------------------
Last Update Date | 09/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2370 PROFESSIONAL DR
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-7745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-782-1033
-----------------------------------------------------
Fax | 916-782-4628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2370 PROFESSIONAL DR
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-7745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-782-1033
-----------------------------------------------------
Fax | 916-782-4628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT CHENG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-782-1033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------