MEDICARE: DR. MIANG CHNEH C TEO 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	060968	NY

General Provider Information

NPI Number	:	1851926513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIANG CHNEH C TEO DDS

Provider Business Mailing Address
First Line	:	135 N 11TH ST APT 2G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-1597
Country	:	US
Telephone Number	:	347-856-9726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 PELHAM PKWY S
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1001
Country	:	US
Telephone Number	:	718-684-3131
Fax Number	:

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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