Individual
FANRUI ZENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
509 LAKE ST APT D4, ITHACA, NY 14850-2163
(732) 458-6799
Mailing address
509 LAKE ST APT D4, ITHACA, NY 14850-2163
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
056763
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03749548
—
NY
Enumeration date
03/13/2012
Last updated
09/08/2014
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