Healthcare Provider Details

I. General information

NPI: 1700038163
Provider Name (Legal Business Name): CONTEMPORARY FACIAL AND ORAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 E. RENNER RD. SUITE 100
PLANO TX
75074
US

IV. Provider business mailing address

3443 E. RENNER RD. SUITE 100
PLANO TX
75074
US

V. Phone/Fax

Practice location:
  • Phone: 214-572-8633
  • Fax: 214-572-8638
Mailing address:
  • Phone: 214-572-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN M CHAN
Title or Position: OWNER
Credential: MD,DDS
Phone: 214-572-8633