=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629104740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YI-JU CHEN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 07/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2337 S. BELTLINE RD STE 100
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-282-9444
-----------------------------------------------------
Fax | 972-282-9446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1618 FM 423 STE 100
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-928-1280
-----------------------------------------------------
Fax | 972-282-9446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 14044
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 27193
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------