Provider Demographics
NPI:1689617896
Name:CHEN, JEN-TAI JEREMY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEN-TAI
Middle Name:JEREMY
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 2ND AVE S
Mailing Address - Street 2:#101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5873
Mailing Address - Country:US
Mailing Address - Phone:253-854-4065
Mailing Address - Fax:253-854-4065
Practice Address - Street 1:221 2ND AVE S
Practice Address - Street 2:#101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5873
Practice Address - Country:US
Practice Address - Phone:253-854-4065
Practice Address - Fax:253-854-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics