Provider Demographics
NPI:1700829793
Name:TAN, KEVIN CHI CHIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHI CHIEN
Last Name:TAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CRESTVIEW CIR
Mailing Address - Street 2:UNIT #115
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2474
Mailing Address - Country:US
Mailing Address - Phone:617-678-0963
Mailing Address - Fax:
Practice Address - Street 1:18 GONIC RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3925
Practice Address - Country:US
Practice Address - Phone:603-332-7800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34321223G0001X
MA210091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice