Provider Demographics
NPI:1508293937
Name:CHEN, CLIFF
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 BRADDOCK RD
Mailing Address - Street 2:109
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2459
Mailing Address - Country:US
Mailing Address - Phone:703-830-9990
Mailing Address - Fax:
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:STE 109
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-830-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014141611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics