Provider Demographics
NPI:1518035849
Name:CHEN, ANDREW DEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DEAN
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:PO BOX 3367
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-1367
Mailing Address - Country:US
Mailing Address - Phone:403-619-7320
Mailing Address - Fax:
Practice Address - Street 1:12195 HIGHWAY 92
Practice Address - Street 2:SUITE 148
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3602
Practice Address - Country:US
Practice Address - Phone:770-517-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523541223X0400X
GADN0147011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics