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General NPI Number Information
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NPI Number | 1568509552
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Entity Type | Organization
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Legal Business Name | RICHARD S CHEN DDS LTD
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 41 LONG ACRE DRIVE
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2644
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Country | US
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Telephone | 618-234-6223
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Fax |
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Provider Business Mailing Address
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Address Line | 41 LONG ACRE DRIVE
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2644
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Country | US
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Telephone | 618-234-6223
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD S CHEN
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Credential | DDS MS
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Telephone | 618-234-6223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | IL
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