Provider Demographics
NPI:1386933422
Name:CHEN, CHESTER (BS)
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LINCOLN ST, STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2400
Mailing Address - Country:US
Mailing Address - Phone:617-338-0833
Mailing Address - Fax:617-338-7177
Practice Address - Street 1:180 LINCOLN ST STE 2A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2400
Practice Address - Country:US
Practice Address - Phone:617-338-0833
Practice Address - Fax:617-338-7177
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH87604124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist