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General NPI Number Information
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NPI Number | 1649450552
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Entity Type | Organization
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Legal Business Name | KATHLEEN CHAN DDS, MMSC & IVY CHEN DDS, MMSC, PC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 16 N MAIN ST SUITE 200
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City | ANDOVER
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State | MA
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Zip | 01810-6518
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Country | US
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Telephone | 978-475-2222
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Fax | 978-475-2290
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Provider Business Mailing Address
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Address Line | 16 N MAIN ST SUITE 200
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City | ANDOVER
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State | MA
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Zip | 01810-6518
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Country | US
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Telephone | 978-475-2222
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Fax | 978-475-2290
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVY CHEN
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Credential | DDS, MMSC
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Telephone | 978-475-2222
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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 | 20548
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License Number State | MA
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