Provider Demographics
NPI:1780849901
Name:CHEN, SAMUEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
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 1:13831 NW CORNELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5485
Mailing Address - Country:US
Mailing Address - Phone:503-644-9797
Mailing Address - Fax:503-439-0308
Practice Address - Street 1:13831 NW CORNELL RD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5485
Practice Address - Country:US
Practice Address - Phone:503-644-9797
Practice Address - Fax:503-439-0308
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice