Provider Demographics
NPI:1104846195
Name:CHEN, JENNIFER M (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:CHEN
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 1:688 HANCOCK ST
Mailing Address - Street 2:QUINCY
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2814
Mailing Address - Country:US
Mailing Address - Phone:617-984-5888
Mailing Address - Fax:617-984-5822
Practice Address - Street 1:688 HANCOCK ST
Practice Address - Street 2:QUINCY
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2814
Practice Address - Country:US
Practice Address - Phone:617-984-5888
Practice Address - Fax:617-984-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201471223G0001X
NY0494071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11526OtherBLUE CROSS BLUE SHIELD
MA0200891OtherMASSHEALTH