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General NPI Number Information
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NPI Number | 1043650849
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Entity Type | Organization
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Legal Business Name | BOSCO P. CHAN, D.D.S.
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 323 W CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2805
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Country | US
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Telephone | 517-278-6077
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Fax | 517-278-7045
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Provider Business Mailing Address
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Address Line | 323 W CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2805
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Country | US
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Telephone | 517-278-6077
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Fax | 517-278-7045
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOSCO PUI-KI CHAN
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Credential | D.D.S.
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Telephone | 517-278-6077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901020908
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901010055
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License Number State | MI
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