Provider Demographics
NPI:1265648570
Name:CHEN, ANDREW H (DDS, FADSA)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:H
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS, FADSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEWBURY ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-480-0092
Mailing Address - Fax:805-480-0998
Practice Address - Street 1:1000 NEWBURY ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-480-0092
Practice Address - Fax:805-480-0998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40215122300000X
CAG10321223D0004X
CAD40215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist