1396762092 NPI number — CHIEN-CHING JUAN, D.M.D., P.C.

Table of content: (NPI 1396762092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396762092 NPI number — CHIEN-CHING JUAN, D.M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIEN-CHING JUAN, D.M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MID-CAPE DENTAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396762092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02638-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-385-9992
Provider Business Mailing Address Fax Number:
508-385-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02638-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-385-9992
Provider Business Practice Location Address Fax Number:
508-385-0092
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JUAN
Authorized Official First Name:
CHIEN-CHING
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
508-385-9992

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  20178 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01423816 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: X12084 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 41873 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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