Provider Demographics
NPI:1902539612
Name:CHEN, VINCENT CHUNWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:CHUNWEN
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 S FOLLETT WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0155
Mailing Address - Country:US
Mailing Address - Phone:626-476-1578
Mailing Address - Fax:
Practice Address - Street 1:3440 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7247
Practice Address - Country:US
Practice Address - Phone:480-926-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist