Provider Demographics
NPI:1154470292
Name:CHEN, EVANGELINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:
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 1:8867 W FLAMINGO RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8726
Mailing Address - Country:US
Mailing Address - Phone:702-880-5858
Mailing Address - Fax:702-880-9889
Practice Address - Street 1:8867 W FLAMINGO RD
Practice Address - Street 2:STE. 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8726
Practice Address - Country:US
Practice Address - Phone:702-880-5858
Practice Address - Fax:702-880-9889
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice