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General NPI Number Information
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NPI Number | 1366198921
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Entity Type | Organization
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Legal Business Name | SPROUT DENTISTRY FOR KIDS ALLEN, PLLC
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 939 W STACY RD STE 140
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City | ALLEN
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State | TX
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Zip | 75013-5049
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Country | US
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Telephone | 469-663-0098
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Fax | 469-663-0097
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Provider Business Mailing Address
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Address Line | 939 W STACY RD STE 140
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City | ALLEN
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State | TX
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Zip | 75013-5049
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Country | US
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Telephone | 469-663-0098
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Fax | 469-663-0097
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/PARTNER
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Name | DR. JUSTIN N CHAN
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Credential | DDS
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Telephone | 469-301-3212
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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