MEDICARE: DR. CHENG GAO DMD

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	DN013199	GA

General Provider Information

NPI Number	:	1548383839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHENG GAO DMD

Provider Business Mailing Address
First Line	:	11055 BOLSTER CT
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-1576
Country	:	US
Telephone Number	:	770-622-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	4897 BUFORD HWY STE 122
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-3670
Country	:	US
Telephone Number	:	770-452-5922
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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