Provider Demographics
NPI:1144897794
Name:CHEN, CONG NONE
Entity type:Individual
Prefix:
First Name:CONG
Middle Name:NONE
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2D DENBN/NDC
Mailing Address - Street 2:PSC 20130 315 MCHUGH BLVD,
Mailing Address - City:CAMP LEJUENE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:
Practice Address - Street 1:2D DENBN/NDC
Practice Address - Street 2:PSC 20130 315 MCHUGH BLVD,
Practice Address - City:CAMP LEJUENE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27851124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist