Provider Demographics
NPI:1952091340
Name:CHEN, SAMUEL DASHAN (DDS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DASHAN
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 1:95 TROUP ST APT 6
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2007
Mailing Address - Country:US
Mailing Address - Phone:303-588-7197
Mailing Address - Fax:
Practice Address - Street 1:1100 LONG POND RD STE 115
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1154
Practice Address - Country:US
Practice Address - Phone:585-225-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist