=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073749206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN LIN CHEN-MIZUUCHI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2009
-----------------------------------------------------
Last Update Date | 04/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 COLLIN MCKINNEY PKWY SUITE 130
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-301-1255
-----------------------------------------------------
Fax | 469-301-1255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 DUNLEER DR
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-5373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-301-1255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 25251
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------