Provider Demographics
NPI:1013394626
Name:HAROLD CHEN DDS PC
Entity Type:Organization
Organization Name:HAROLD CHEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-651-6581
Mailing Address - Street 1:8616 WHITNEY AVE. 1FL
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-651-6581
Mailing Address - Fax:
Practice Address - Street 1:8616 WHITNEY AVE
Practice Address - Street 2:1 FL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3658
Practice Address - Country:US
Practice Address - Phone:718-651-6581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0556801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03368274Medicaid