MEDICARE: JENNIFER M CHEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20147	MA
2	1223G0001X	General Practice Dentistry	049407	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X11526	OTHER	MA	BLUE CROSS BLUE SHIELD
2	0200891	OTHER	MA	MASSHEALTH

General Provider Information

NPI Number	:	1104846195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M CHEN DMD

Provider Business Mailing Address
First Line	:	688 HANCOCK ST
Second Line	:	QUINCY
City	:	QUINCY
State	:	MA
Zip	:	02170-2814
Country	:	US
Telephone Number	:	617-984-5888
Fax Number	:	617-984-5822

Provider Business Practice Location Address
First Line	:	688 HANCOCK ST
Second Line	:	QUINCY
City	:	QUINCY
State	:	MA
Zip	:	02170-2814
Country	:	US
Telephone Number	:	617-984-5888
Fax Number	:	617-984-5822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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Directions to “ JENNIFER M CHEN DMD” Practice Location

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