Provider Demographics
NPI:1891932315
Name:CHEN, CHRISTOPHER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
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 1:22W029 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3637
Mailing Address - Country:US
Mailing Address - Phone:630-532-3406
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4319
Practice Address - Country:US
Practice Address - Phone:630-892-7041
Practice Address - Fax:630-892-0241
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19027612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist