Provider Demographics
NPI:1972684686
Name:CHEN, KENNETH K (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
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 1:131 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1441
Mailing Address - Country:US
Mailing Address - Phone:201-947-6060
Mailing Address - Fax:201-461-0544
Practice Address - Street 1:131 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1441
Practice Address - Country:US
Practice Address - Phone:201-947-6060
Practice Address - Fax:201-461-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022725001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice