Provider Demographics
NPI:1407845894
Name:CHEN, JOHN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
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 1:7 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1846
Mailing Address - Country:US
Mailing Address - Phone:908-722-6500
Mailing Address - Fax:908-722-7206
Practice Address - Street 1:7 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1846
Practice Address - Country:US
Practice Address - Phone:908-722-6500
Practice Address - Fax:908-722-7206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0559300Medicaid