Provider Demographics
NPI:1073567673
Name:CHU, MAYLENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAYLENE
Middle Name:
Last Name:CHU
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 1:2 ANDOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821
Mailing Address - Country:US
Mailing Address - Phone:978-667-8600
Mailing Address - Fax:978-663-2880
Practice Address - Street 1:2 ANDOVER ROAD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-667-8600
Practice Address - Fax:978-663-2880
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4041204E00000X
MA215061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4041Medicaid
SCV00580Medicare UPIN