Healthcare Provider Details

I. General information

NPI: 1144897794
Provider Name (Legal Business Name): CONG NONE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D DENBN/NDC PSC 20130 315 MCHUGH BLVD,
CAMP LEJUENE NC
28542
US

IV. Provider business mailing address

2D DENBN/NDC PSC 20130 315 MCHUGH BLVD,
CAMP LEJUENE NC
28542
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-2208
  • Fax:
Mailing address:
  • Phone: 910-451-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH27851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: