Provider Demographics
NPI:1396150322
Name:CHEUNG, TRACY (DDS MS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 N STATE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1478
Mailing Address - Country:US
Mailing Address - Phone:914-923-5089
Mailing Address - Fax:888-972-4796
Practice Address - Street 1:449 N STATE RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1478
Practice Address - Country:US
Practice Address - Phone:914-923-5089
Practice Address - Fax:888-972-4796
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics