Healthcare Provider Details

I. General information

NPI: 1336450998
Provider Name (Legal Business Name): STEPHEN JOSEPH CHEN DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 FALLBROOK DR #201
HOUSTON TX
77065-4238
US

IV. Provider business mailing address

11455 FALLBROOK DR #201
HOUSTON TX
77065-4238
US

V. Phone/Fax

Practice location:
  • Phone: 832-237-4746
  • Fax: 281-890-4862
Mailing address:
  • Phone: 832-237-4746
  • Fax: 281-890-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25655
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number25655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: