Provider Demographics
NPI:1659264653
Name:CHEN, GAVIN LLORENS (DMD)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:LLORENS
Last Name:CHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16296 RUST HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-8278
Mailing Address - Country:US
Mailing Address - Phone:775-741-6198
Mailing Address - Fax:
Practice Address - Street 1:616 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9706
Practice Address - Country:US
Practice Address - Phone:276-525-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist