MEDICARE: DR. EMILY NICOLE CHAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12818	NC

General Provider Information

NPI Number	:	1902539224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY NICOLE CHAN DMD

Provider Business Mailing Address
First Line	:	221 THUNDER FOREST LN
Second Line	:
City	:	WENDELL
State	:	NC
Zip	:	27591-4425
Country	:	US
Telephone Number	:	617-777-3608
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 HEMBY LN
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3775
Country	:	US
Telephone Number	:	252-752-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/06/2022

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