Provider Demographics
NPI:1114021565
Name:CHEN, TOM TP (DDS)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:TP
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16900 GOLDENWEST ST
Mailing Address - Street 2:STE. A
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8405
Mailing Address - Country:US
Mailing Address - Phone:714-375-2436
Mailing Address - Fax:
Practice Address - Street 1:16900 GOLDENWEST ST
Practice Address - Street 2:STE. A
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-8405
Practice Address - Country:US
Practice Address - Phone:714-375-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist