Provider Demographics
NPI:1437824703
Name:MA, YI-CHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YI-CHEN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:101 SHATTUCK WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7876
Mailing Address - Country:US
Mailing Address - Phone:603-436-9200
Mailing Address - Fax:
Practice Address - Street 1:101 SHATTUCK WAY STE 5
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7876
Practice Address - Country:US
Practice Address - Phone:603-436-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859148122300000X
NH04699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist