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General NPI Number Information
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NPI Number | 1053195487
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Entity Type | Individual
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Provider Name | CHRISTINA CHEN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1565 MATTHEW DR STE 1
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City | FORT MYERS
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State | FL
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Zip | 33907-1734
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Country | US
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Telephone | 239-275-7907
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Fax |
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Provider Business Mailing Address
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Address Line | 14031 W HYDE PARK DR APT 201
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City | FORT MYERS
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State | FL
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Zip | 33912-0210
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Country | US
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Telephone |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 28226
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License Number State | FL
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