Provider Demographics
NPI:1568678365
Name:STEPHANIE CHEN DDS MS PA
Entity Type:Organization
Organization Name:STEPHANIE CHEN DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-365-0888
Mailing Address - Street 1:2813 COLTSGATE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3798
Mailing Address - Country:US
Mailing Address - Phone:704-365-0888
Mailing Address - Fax:704-365-0889
Practice Address - Street 1:2813 COLTSGATE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3798
Practice Address - Country:US
Practice Address - Phone:704-365-0888
Practice Address - Fax:704-365-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7991547Medicaid