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General NPI Number Information
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NPI Number | 1518132497
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Entity Type | Individual
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Provider Name | CLAYTON ALEXANDER CHAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1975 VILLAGE CENTER CIR STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89134-6255
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Country | US
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Telephone | 702-271-2950
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Fax | 702-304-8008
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Provider Business Mailing Address
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Address Line | 3007 SOFT HORIZON WAY
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City | LAS VEGAS
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State | NV
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Zip | 89135-1741
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Country | US
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Telephone | 702-271-2950
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Fax | 702-304-8008
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4100
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36067
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License Number State | CA
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