Healthcare Provider Details

I. General information

NPI: 1457955379
Provider Name (Legal Business Name): PETER H CHEN DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 EAST 79TH ST UNIT 1B
NEW YORK NY
10075
US

IV. Provider business mailing address

325 EAST 79TH ST UNIT 1B
NEW YORK NY
10075
US

V. Phone/Fax

Practice location:
  • Phone: 212-897-1833
  • Fax:
Mailing address:
  • Phone: 212-897-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PETER CHEN
Title or Position: OWNER
Credential: DDS
Phone: 212-897-1833