Provider Demographics
NPI:1194887661
Name:CHAN, WILLIAM B (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:CHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3707
Mailing Address - Country:US
Mailing Address - Phone:401-334-3070
Mailing Address - Fax:401-334-9031
Practice Address - Street 1:2359 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3707
Practice Address - Country:US
Practice Address - Phone:401-334-3070
Practice Address - Fax:401-334-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN019681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry