Provider Demographics
NPI:1912127846
Name:CHEN, ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
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 1:15165 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5544
Mailing Address - Country:US
Mailing Address - Phone:425-562-2919
Mailing Address - Fax:425-562-2701
Practice Address - Street 1:15165 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5544
Practice Address - Country:US
Practice Address - Phone:425-562-2919
Practice Address - Fax:425-562-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000088251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice