Provider Demographics
NPI:1295163673
Name:GRACE CHEN DDS LLC
Entity type:Organization
Organization Name:GRACE CHEN DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:808-961-5766
Mailing Address - Street 1:1234 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4282
Mailing Address - Country:US
Mailing Address - Phone:808-961-5766
Mailing Address - Fax:808-935-5985
Practice Address - Street 1:1234 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4282
Practice Address - Country:US
Practice Address - Phone:808-961-5766
Practice Address - Fax:808-935-5985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE CHEN DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 23081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty