Provider Demographics
NPI:1538494638
Name:CHEN, JESSICA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:C
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VICTORY AVE APT 1307
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7679
Mailing Address - Country:US
Mailing Address - Phone:408-892-9073
Mailing Address - Fax:
Practice Address - Street 1:2200 VICTORY AVE APT 1307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-7679
Practice Address - Country:US
Practice Address - Phone:408-892-9073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58587122300000X
TX286971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist