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General NPI Number Information
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NPI Number | 1144508292
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Entity Type | Individual
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Provider Name | JUSTIN NILE CHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 07/04/2024
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Provider Practice Location Address
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Address Line | 6675 S CUSTER RD STE 200
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City | MCKINNEY
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State | TX
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Zip | 75070-1838
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Country | US
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Telephone | 469-301-3212
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Fax | 469-301-3213
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Provider Business Mailing Address
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Address Line | 6675 S CUSTER RD STE 200
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City | MCKINNEY
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State | TX
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Zip | 75070-1838
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Country | US
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Telephone | 469-301-3212
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Fax | 469-301-3213
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 27969
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License Number State | TX
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