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General NPI Number Information
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NPI Number | 1457710717
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Entity Type | Organization
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Legal Business Name | CHUN W. PENG DMD, PLLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 9115 SAMLEN LN SUITE 105
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City | CHARLOTTE
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State | NC
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Zip | 28214-3360
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Country | US
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Telephone | 704-398-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 9115 SAMLEN LN SUITE 105
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City | CHARLOTTE
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State | NC
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Zip | 28214-3360
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Country | US
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Telephone | 704-398-9299
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHUN WEI PENG
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Credential | D.M.D.
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Telephone | 704-398-9299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9962
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License Number State | NC
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