MEDICARE: DR. EDWARD CHENG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019027647	IL
2	1223G0001X	General Practice Dentistry	6276-15	WI

General Provider Information

NPI Number	:	1306007703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CHENG DDS

Provider Business Mailing Address
First Line	:	5802 WASHINGTON AVE
Second Line	:	STE 202
City	:	RACINE
State	:	WI
Zip	:	53406-4050
Country	:	US
Telephone Number	:	262-886-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 WASHINGTON AVE
Second Line	:	STE 202
City	:	RACINE
State	:	WI
Zip	:	53406-4050
Country	:	US
Telephone Number	:	262-886-1957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	07/01/2008

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