Provider Demographics
NPI:1568684108
Name:CHEN, ELLAINE SAAVEDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLAINE
Middle Name:SAAVEDRA
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLAINE
Other - Middle Name:BUCOY
Other - Last Name:SAAVEDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3845 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2763
Mailing Address - Country:US
Mailing Address - Phone:626-388-4457
Mailing Address - Fax:
Practice Address - Street 1:17980 CASTLETON ST STE 2
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1850
Practice Address - Country:US
Practice Address - Phone:626-388-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice