Provider Demographics
NPI:1821282187
Name:CHEN, ERIC H (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
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 1:259 MERIDIAN AVE
Mailing Address - Street 2:17
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2905
Mailing Address - Country:US
Mailing Address - Phone:408-293-6816
Mailing Address - Fax:415-392-0908
Practice Address - Street 1:259 MERIDIAN AVE
Practice Address - Street 2:17
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2905
Practice Address - Country:US
Practice Address - Phone:408-293-6816
Practice Address - Fax:415-392-0908
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice