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General NPI Number Information
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NPI Number | 1417256256
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Entity Type | Organization
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Legal Business Name | ANN BESS CHANCO DENTAL PROF CORP
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 3862 SMITH ST
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City | UNION CITY
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State | CA
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Zip | 94587-2614
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Country | US
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Telephone | 510-441-2621
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Fax | 510-441-2626
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Provider Business Mailing Address
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Address Line | 3862 SMITH ST
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City | UNION CITY
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State | CA
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Zip | 94587-2614
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Country | US
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Telephone | 510-441-2621
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Fax | 510-441-2626
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANN BESS CHANCO
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Credential | DMD
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Telephone | 510-441-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46460
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License Number State | CA
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