Provider Demographics
NPI:1144467234
Name:CHEN, STANFORD (DDS)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:
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 1:12360 NE 8TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4802
Mailing Address - Country:US
Mailing Address - Phone:425-453-2222
Mailing Address - Fax:
Practice Address - Street 1:12360 NE 8TH ST STE 250
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4802
Practice Address - Country:US
Practice Address - Phone:425-453-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57741122300000X
WA60129770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60129770OtherSTATE LICENSE