Peter S Chen, D.M.D., M.M.SC.
Individual provider Active NPI Endodontics · Clermont, FL
NPI 1013073568 · NPPES record last updated Jun 20, 2018
Key facts
- NPI
- 1013073568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 17794 (FL)
- Practice address
- 1471 Johns Lake Rd Ste 1
Clermont, FL 34711 - Phone
- (617) 784-1970
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150423000754 | FL | Order and Referring Only - Dentist |
4486972437 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17794 | FL | MD | Endodontist |
| 20256 | MA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Endodontics of Volusia, P.a. | Current | Accepting new patients | |
| RN Dental Care PLLC | Current | Accepting new patients |
Locations
1471 Johns Lake Rd
Ste 1
Clermont, FL 34711
Phone (352) 404-5550
743 Stirling Center Pl
Ste 1701
Lake Mary, FL 32746
Phone (352) 404-5550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 20256 | MA | |
| Endodontics | 1223E0200X | 17794 | FL | Yes |
Addresses
Primary practice location
1471 Johns Lake Rd Ste 1
Clermont, FL 34711
Mailing address
1471 Johns Lake Rd Ste 1
Clermont, FL 34711-7005
Phone (617) 784-1970
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X11812 | Other | MA | BLUE CROSS & BLUE SHIELD |
| 1942689807 | Other | FL | NPI TYPE 2 |
Other providers in Clermont, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.