Provider Demographics
NPI:1821413253
Name:CHEN, MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:1001 AVENUE D
Mailing Address - Street 2:STE 100
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2018
Mailing Address - Country:US
Mailing Address - Phone:360-568-9694
Mailing Address - Fax:360-568-9684
Practice Address - Street 1:1001 AVENUE D
Practice Address - Street 2:STE 100
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2018
Practice Address - Country:US
Practice Address - Phone:360-568-9694
Practice Address - Fax:360-568-9684
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024114122300000X
WADE60660218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist