MEDICARE: TIFFANY CHEN

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	122300000X	Dentist	32162	TX
2	122300000X	Dentist	13100	NC
3	1223G0001X	General Practice Dentistry	32162	TX
4	390200000X	Student in an Organized Health Care Education/Training Program
5	1223G0001X	General Practice Dentistry	13100	NC

General Provider Information

NPI Number	:	1871957019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CHEN

Provider Business Mailing Address
First Line	:	350 N CLARK ST FL 6
Second Line	:	DENTAL DREAMS LLC C/O JULIETTE BOYCE
City	:	CHICAGO
State	:	IL
Zip	:	60654-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 BEREWICK TOWN CENTER DR STE J
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6733
Country	:	US
Telephone Number	:	704-800-0252
Fax Number	:

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	07/04/2023

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Directions to “ TIFFANY CHEN ” Practice Location

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