MEDICARE: SAMUEL DASHAN CHEN DDS

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	063969	NY

General Provider Information

NPI Number	:	1952091340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DASHAN CHEN DDS

Provider Business Mailing Address
First Line	:	95 TROUP ST APT 6
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-2007
Country	:	US
Telephone Number	:	303-588-7197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 LONG POND RD STE 115
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-1154
Country	:	US
Telephone Number	:	585-225-7790
Fax Number	:

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	08/12/2024

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