Healthcare Provider Details

I. General information

NPI: 1598072001
Provider Name (Legal Business Name): Q.M. CHEN, D.M.D., PH.D, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 PLANTATION CENTER DR
MATTHEWS NC
28105-5298
US

IV. Provider business mailing address

2504 PLANTATION CENTER DR
MATTHEWS NC
28105-5298
US

V. Phone/Fax

Practice location:
  • Phone: 704-841-2237
  • Fax: 704-841-8260
Mailing address:
  • Phone: 704-841-2237
  • Fax: 704-841-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. QING MING CHEN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 704-298-9299