Healthcare Provider Details

I. General information

NPI: 1194887661
Provider Name (Legal Business Name): WILLIAM B CHAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 MENDON RD
CUMBERLAND RI
02864-3707
US

IV. Provider business mailing address

2359 MENDON RD
CUMBERLAND RI
02864-3707
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-3070
  • Fax: 401-334-9031
Mailing address:
  • Phone: 401-334-3070
  • Fax: 401-334-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN01968
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: