Provider Demographics
NPI:1629156641
Name:CHEN, STEPHANIE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC63241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7991547Medicaid