Provider Demographics
NPI:1114354917
Name:GRACE CHEN DDS LLC
Entity Type:Organization
Organization Name:GRACE CHEN DDS LLC
Other - Org Name:GRACEDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-933-9008
Mailing Address - Street 1:31 E LANIKAULA ST STE B
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4362
Mailing Address - Country:US
Mailing Address - Phone:808-969-3830
Mailing Address - Fax:
Practice Address - Street 1:31 E LANIKAULA ST STE B
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4362
Practice Address - Country:US
Practice Address - Phone:808-969-3830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACEDENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 23081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty