Provider Demographics
NPI:1326267634
Name:MICHAEL J CHEN, D.D.S. INC.
Entity Type:Organization
Organization Name:MICHAEL J CHEN, D.D.S. INC.
Other - Org Name:TUSTIN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-731-6677
Mailing Address - Street 1:17482 IRVINE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3032
Mailing Address - Country:US
Mailing Address - Phone:714-731-6677
Mailing Address - Fax:
Practice Address - Street 1:17482 IRVINE BLVD STE F
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3032
Practice Address - Country:US
Practice Address - Phone:714-731-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty