Healthcare Provider Details

I. General information

NPI: 1821142423
Provider Name (Legal Business Name): CHIEN-CHING JUAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN ST
DENNIS MA
02638-1904
US

IV. Provider business mailing address

PO BOX 605
DENNIS MA
02638-0605
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-9992
  • Fax:
Mailing address:
  • Phone: 508-385-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: