Provider Demographics
NPI:1700035607
Name:CHEN, CYNTHIA (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
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 1:1925 W CHICAGO AVE
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5541
Mailing Address - Country:US
Mailing Address - Phone:312-363-8248
Mailing Address - Fax:
Practice Address - Street 1:430 W. ERIE ST.
Practice Address - Street 2:STE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-274-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist