MEDICARE: BOB CHENG D.M.D

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	1223G0001X	General Practice Dentistry	1856560	MA

General Provider Information

NPI Number	:	1407294739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOB CHENG D.M.D

Provider Business Mailing Address
First Line	:	67 MONTVALE AVE
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 MONTVALE AVE
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3618
Country	:	US
Telephone Number	:	781-279-2400
Fax Number	:

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

Provider Enumeration Date	:	06/09/2013
Last Update Date	:	12/10/2014

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