Provider Demographics
NPI:1821251596
Name:CHEN, JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:CHEN
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 1:122 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5548
Mailing Address - Country:US
Mailing Address - Phone:770-601-6640
Mailing Address - Fax:
Practice Address - Street 1:1103 7TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3501
Practice Address - Country:US
Practice Address - Phone:229-436-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist