Healthcare Provider Details

I. General information

NPI: 1477497063
Provider Name (Legal Business Name): ALICE CHAN DMD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 HOLMES ST
QUINCY MA
02171-2431
US

IV. Provider business mailing address

255 HANCOCK ST APT 2627
QUINCY MA
02171-2578
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-3200
  • Fax: 617-457-6600
Mailing address:
  • Phone: 321-750-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: