MEDICARE: WALTER CHEN DENTAL CARE PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1093542748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER CHEN DENTAL CARE PC

Provider Business Mailing Address
First Line	:	7410 20TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5703
Country	:	US
Telephone Number	:	718-759-6226
Fax Number	:	718-759-6222

Provider Business Practice Location Address
First Line	:	7410 20TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5703
Country	:	US
Telephone Number	:	718-759-6226
Fax Number	:	718-759-6222

Authorized Official
Title or Position	:	OWNER
Name	:	WALTER CHEN
Credential	:	DDS
Telephone Number	:	718-759-6226

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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