Provider Demographics
NPI:1124032925
Name:CHEN, LISA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1490
Mailing Address - Country:US
Mailing Address - Phone:909-465-0909
Mailing Address - Fax:909-465-0493
Practice Address - Street 1:3277 GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1490
Practice Address - Country:US
Practice Address - Phone:909-465-0909
Practice Address - Fax:909-465-0493
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice