MEDICARE: DR. JOHNNY SHU-LUAN CHENG D.D.S.

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	19070	TX

General Provider Information

NPI Number	:	1871713545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY SHU-LUAN CHENG D.D.S.

Provider Business Mailing Address
First Line	:	4900 OVERTON RIDGE BLVD
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1940
Country	:	US
Telephone Number	:	817-292-5957
Fax Number	:	817-292-0763

Provider Business Practice Location Address
First Line	:	4900 OVERTON RIDGE BLVD
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1940
Country	:	US
Telephone Number	:	817-292-5957
Fax Number	:	817-292-0763

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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