Provider Demographics
NPI:1912355744
Name:CHEN, NAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAN
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 1:15 YOUNG ST APT 9
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1983
Mailing Address - Country:US
Mailing Address - Phone:347-503-9121
Mailing Address - Fax:
Practice Address - Street 1:15 COLUMBIA RD STE 2
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1967
Practice Address - Country:US
Practice Address - Phone:781-499-5438
Practice Address - Fax:508-872-5483
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist