Provider Demographics
NPI:1629104740
Name:CHEN, YI-JU (DDS)
Entity Type:Individual
Prefix:DR
First Name:YI-JU
Middle Name:
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 1:2337 S. BELTLINE RD.
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051
Mailing Address - Country:US
Mailing Address - Phone:972-282-9444
Mailing Address - Fax:972-282-9446
Practice Address - Street 1:2337 S. BELTLINE RD
Practice Address - Street 2:STE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051
Practice Address - Country:US
Practice Address - Phone:972-282-9444
Practice Address - Fax:972-282-9446
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140441223P0221X
TX271931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284082901Medicaid