Healthcare Provider Details

I. General information

NPI: 1669308490
Provider Name (Legal Business Name): CEDAR PARK A PLUS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S LAKELINE BLVD BLDG 1-130
CEDAR PARK TX
78613-2767
US

IV. Provider business mailing address

120 S LAKELINE BLVD BLDG 1-130
CEDAR PARK TX
78613-2767
US

V. Phone/Fax

Practice location:
  • Phone: 408-673-0956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHUN-YU FAN
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 408-768-7098