Provider Demographics
NPI:1205091196
Name:CHEN, QING MING (DMD)
Entity type:Individual
Prefix:
First Name:QING MING
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 FREEDOM DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3861
Mailing Address - Country:US
Mailing Address - Phone:704-393-3911
Mailing Address - Fax:704-392-1196
Practice Address - Street 1:2211 EXECUTIVE ST
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3661
Practice Address - Country:US
Practice Address - Phone:704-395-6000
Practice Address - Fax:704-398-7373
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist