Healthcare Provider Details

I. General information

NPI: 1235333741
Provider Name (Legal Business Name): STEPHEN M CHAN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 HEDGCOXE RD STE 300
PLANO TX
75024-2411
US

IV. Provider business mailing address

4865 HEDGCOXE RD STE 300
PLANO TX
75024-2411
US

V. Phone/Fax

Practice location:
  • Phone: 972-505-2210
  • Fax:
Mailing address:
  • Phone: 972-505-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22370
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22370
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22370
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: