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General NPI Number Information
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NPI Number | 1013073568
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Entity Type | Individual
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Provider Name | PETER S CHEN D.M.D., M.M.SC.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1471 JOHNS LAKE RD STE 1
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 617-784-1970
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 JOHNS LAKE RD STE 1
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City | CLERMONT
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State | FL
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Zip | 34711-7005
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Country | US
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Telephone | 617-784-1970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 20256
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17794
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License Number State | FL
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