Provider Demographics
NPI:1710046834
Name:CHEN, PHIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 MITCHELL ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351
Mailing Address - Country:US
Mailing Address - Phone:209-538-1010
Mailing Address - Fax:209-538-3440
Practice Address - Street 1:1460 MITCHELL ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351
Practice Address - Country:US
Practice Address - Phone:209-538-1010
Practice Address - Fax:209-538-3440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice