Provider Demographics
NPI:1467598292
Name:CHEN, TIMOTHY PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PETER
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 1:12781 MIRAMAR PKWY
Mailing Address - Street 2:306
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2906
Mailing Address - Country:US
Mailing Address - Phone:954-699-5554
Mailing Address - Fax:
Practice Address - Street 1:12781 MIRAMAR PKWY
Practice Address - Street 2:306
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2906
Practice Address - Country:US
Practice Address - Phone:954-699-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL166821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076528700Medicaid