Provider Demographics
NPI:1134808314
Name:CHEN, DONG HONG (DDS)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:HONG
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 1:581 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5200
Mailing Address - Country:US
Mailing Address - Phone:857-364-7985
Mailing Address - Fax:
Practice Address - Street 1:581 2ND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5200
Practice Address - Country:US
Practice Address - Phone:603-932-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2024-11-06
Deactivation Date:2024-02-20
Deactivation Code:
Reactivation Date:2024-07-10
Provider Licenses
StateLicense IDTaxonomies
MADN100005951223G0001X
390200000X
NH050961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program