MEDICARE: STEPHANIE CHEN DDS MS PA

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	1223P0221X	Pediatric Dentistry	6324	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568678365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE CHEN DDS MS PA

Provider Business Mailing Address
First Line	:	2813 COLTSGATE RD
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3798
Country	:	US
Telephone Number	:	704-365-0888
Fax Number	:	704-365-0889

Provider Business Practice Location Address
First Line	:	2813 COLTSGATE RD
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3798
Country	:	US
Telephone Number	:	704-365-0888
Fax Number	:	704-365-0889

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GLORIA D EDAHL
Credential	:
Telephone Number	:	704-365-0888

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	09/11/2007

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