MEDICARE: ERIC 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	42064	TX

General Provider Information

NPI Number	:	1508611773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHEN DMD

Provider Business Mailing Address
First Line	:	13450 N HWY 183
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-3239
Country	:	US
Telephone Number	:	512-596-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	13450 N HWY 183
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-3239
Country	:	US
Telephone Number	:	512-596-0021
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	03/04/2026

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