Healthcare Provider Details

I. General information

NPI: 1316872682
Provider Name (Legal Business Name): AUSTIN CHAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BABCOCK ST NE STE 4
PALM BAY FL
32905-4637
US

IV. Provider business mailing address

5201 BABCOCK ST NE STE 4
PALM BAY FL
32905-4637
US

V. Phone/Fax

Practice location:
  • Phone: 321-342-3368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: