Provider Demographics
NPI:1154415651
Name:CHEUNG, FRED K (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:K
Last Name:CHEUNG
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 1:1645 JOHN F KENNEDY ROAD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5107
Mailing Address - Country:US
Mailing Address - Phone:563-556-6383
Mailing Address - Fax:563-556-0461
Practice Address - Street 1:1645 JOHN F KENNEDY ROAD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5107
Practice Address - Country:US
Practice Address - Phone:563-556-6383
Practice Address - Fax:563-556-0461
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060511223P0221X
WI2576-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33414200Medicaid
IA0159517Medicaid