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NPI Code Detail

MEDICARE: DR. LILY CHEN DDS

MEDICARE: DR. LILY CHEN DDS
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
11223G0001XGeneral Practice DentistryD011152AZ

General Provider Information

NPI Number : 1548886955
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LILY CHEN DDS
Provider Business Mailing Address
First Line : 1690 S SAN TAN VILLAGE PKWY APT 3102
Second Line :
City : GILBERT
State : AZ
Zip : 85295-0469
Country : US
Telephone Number : 626-319-6437
Fax Number :
Provider Business Practice Location Address
First Line : 3440 E BASELINE RD STE 106
Second Line :
City : MESA
State : AZ
Zip : 85204-7247
Country : US
Telephone Number : 480-926-2350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2020
Last Update Date : 07/29/2021

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