=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720546187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEILA CHAN DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2019
-----------------------------------------------------
Last Update Date | 03/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 S CENTER RD
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48638-6112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-799-6250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 S CENTER RD
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48638-6112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-799-6250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | DR. SHEILA CHAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 989-799-6250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------