MEDICARE: CLARE CHENGQIN MA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	04501	NH

General Provider Information

NPI Number	:	1023679339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE CHENGQIN MA DMD

Provider Business Mailing Address
First Line	:	9 APACHE AVE
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-4738
Country	:	US
Telephone Number	:	978-886-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	19703 1ST AVE S
Second Line	:
City	:	NORMANDY PARK
State	:	WA
Zip	:	98148-2401
Country	:	US
Telephone Number	:	206-466-3808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	04/28/2025

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