Provider Demographics
NPI:1982133385
Name:CHEUNG, STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
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 1:1420 S MILLS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4291
Mailing Address - Country:US
Mailing Address - Phone:209-369-3617
Mailing Address - Fax:209-369-0498
Practice Address - Street 1:1420 S MILLS AVE STE D
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4291
Practice Address - Country:US
Practice Address - Phone:209-369-3617
Practice Address - Fax:209-369-0498
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022200122300000X
CADDS101878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist