Provider Demographics
NPI:1700966371
Name:CHEN, CHIA-EN JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:CHIA-EN
Middle Name:JOHN
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 1:84 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9115
Mailing Address - Country:US
Mailing Address - Phone:614-880-0576
Mailing Address - Fax:614-880-0576
Practice Address - Street 1:84 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9115
Practice Address - Country:US
Practice Address - Phone:614-880-0576
Practice Address - Fax:614-880-0576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300201971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice