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General NPI Number Information
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NPI Number | 1487904306
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Entity Type | Organization
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Legal Business Name | BRIAN G. CHAN, DMD, PC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 6880 SOUTH MCCARRAN BLVD STE. 9
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City | RENO
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State | NV
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Zip | 89509-6129
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Country | US
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Telephone | 775-825-8366
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Fax |
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Provider Business Mailing Address
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Address Line | 6880 SOUTH MCCARRAN BLVD #9
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City | RENO
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State | NV
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Zip | 89509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN CHAN
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Credential | DMD
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Telephone | 775-393-9548
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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 | 5642
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License Number State | NV
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