Provider Demographics
NPI:1760736243
Name:GRACE CHEN DDS LLC
Entity Type:Organization
Organization Name:GRACE CHEN DDS LLC
Other - Org Name:GRACEDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BING
Authorized Official - Middle Name:
Authorized Official - Last Name:CDHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-933-3130
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 712
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-744-4433
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 712
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4404
Practice Address - Country:US
Practice Address - Phone:808-744-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT23081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI597718-05Medicaid