Provider Demographics
NPI:1235104415
Name:CHEN, RICHARD ETHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ETHAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 N. BUFFALO DRIVE
Mailing Address - Street 2:SUITE #109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-796-0808
Mailing Address - Fax:702-341-0809
Practice Address - Street 1:1780 N. BUFFALO DRIVE
Practice Address - Street 2:SUITE #109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-796-0808
Practice Address - Fax:702-341-0809
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice