MEDICARE: DR. RICHARD ETHAN CHEN 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	4816	NV

General Provider Information

NPI Number	:	1235104415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ETHAN CHEN DMD

Provider Business Mailing Address
First Line	:	1780 N. BUFFALO DRIVE
Second Line	:	SUITE #109
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-796-0808
Fax Number	:	702-341-0809

Provider Business Practice Location Address
First Line	:	1780 N. BUFFALO DRIVE
Second Line	:	SUITE #109
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-796-0808
Fax Number	:	702-341-0809

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	05/16/2016

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