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General NPI Number Information
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NPI Number | 1811475437
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Entity Type | Individual
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Provider Name | JONATHAN CHEN DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 07/02/2023
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Provider Practice Location Address
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Address Line | 5597 TULIP ST STE B4
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City | PHILADELPHIA
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State | PA
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Zip | 19124-1562
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Country | US
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Telephone | 215-288-8008
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Fax |
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Provider Business Mailing Address
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Address Line | DENTAL DREAMS LLC, C/O MARINA MILLER 350 N. CLARK STREET, 6TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02830800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS041910
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | NJDCATEMP-037778
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 062392
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License Number State | NY
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