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General NPI Number Information
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NPI Number | 1437564507
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Entity Type | Organization
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Legal Business Name | STEPHEN L. CHAN , D.M.D , INC.
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 4700 SPRING ST STE. 210
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City | LA MESA
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State | CA
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Zip | 91942-0263
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Country | US
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Telephone | 619-464-2801
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Fax | 619-464-2802
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Provider Business Mailing Address
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Address Line | 4700 SPRING ST STE. 210
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City | LA MESA
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State | CA
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Zip | 91942-0263
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Country | US
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Telephone | 619-464-2801
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Fax | 619-464-2802
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEPHEN L CHAN
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Credential | DENTIST
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Telephone | 619-464-2801
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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 | 36345
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License Number State | CA
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