Provider Demographics
NPI:1104373513
Name:LISA CHEN DMD PLLC
Entity Type:Organization
Organization Name:LISA CHEN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-947-0077
Mailing Address - Street 1:15955 NE 85TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15955 NE 85TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3550
Practice Address - Country:US
Practice Address - Phone:425-947-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00008887261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental