Provider Demographics
NPI:1912285909
Name:CHEN, TABITHA N (DDS)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:N
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 NATIONAL BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3670
Mailing Address - Country:US
Mailing Address - Phone:925-457-7801
Mailing Address - Fax:
Practice Address - Street 1:10520 NATIONAL BLVD APT 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3670
Practice Address - Country:US
Practice Address - Phone:925-457-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist