Provider Demographics
NPI:1316677867
Name:CHENG, JENNIFER C (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:CHENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 WESTLAKE AVE N UNIT S411
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4888
Mailing Address - Country:US
Mailing Address - Phone:848-702-9928
Mailing Address - Fax:
Practice Address - Street 1:527 BOREN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5502
Practice Address - Country:US
Practice Address - Phone:206-274-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61298327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist