Provider Demographics
NPI:1104945807
Name:CHENG, XIAOFANG (DDS)
Entity type:Individual
Prefix:
First Name:XIAOFANG
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12434 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4086
Mailing Address - Country:US
Mailing Address - Phone:954-341-1888
Mailing Address - Fax:954-341-1666
Practice Address - Street 1:12434 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4086
Practice Address - Country:US
Practice Address - Phone:954-341-1888
Practice Address - Fax:954-341-1666
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist