=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700038163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY FACIAL AND ORAL SURGERY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2008
-----------------------------------------------------
Last Update Date | 07/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3443 E. RENNER RD. SUITE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-572-8633
-----------------------------------------------------
Fax | 214-572-8638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3443 E. RENNER RD. SUITE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-572-8633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEPHEN M CHAN
-----------------------------------------------------
Credential | MD,DDS
-----------------------------------------------------
Telephone | 214-572-8633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------