Provider Demographics
NPI:1962574210
Name:CHEN, CHARLES H (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
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 1:1632 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3602
Mailing Address - Country:US
Mailing Address - Phone:847-328-3573
Mailing Address - Fax:847-328-3658
Practice Address - Street 1:1632 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3602
Practice Address - Country:US
Practice Address - Phone:847-328-3573
Practice Address - Fax:847-328-3658
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice