Provider Demographics
NPI:1205027968
Name:CHEN, KENNETH GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GEORGE
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 1:225 COPPER OAK CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1316
Mailing Address - Country:US
Mailing Address - Phone:760-845-6334
Mailing Address - Fax:
Practice Address - Street 1:225 COPPER OAK CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1316
Practice Address - Country:US
Practice Address - Phone:760-845-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545221223G0001X
FLDN207681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice