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General NPI Number Information
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NPI Number | 1083901631
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Entity Type | Individual
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Provider Name | STACEY LEI-LING CHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 101 LAKE HAYES RD STE 101
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City | OVIEDO
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State | FL
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Zip | 32765-9097
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Country | US
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Telephone | 407-845-9000
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Fax | 407-809-5668
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Provider Business Mailing Address
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Address Line | 101 LAKE HAYES RD STE 101
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City | OVIEDO
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State | FL
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Zip | 32765-9097
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Country | US
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Telephone | 407-845-9000
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Fax | 407-809-5668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN19673
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License Number State | FL
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