Provider Demographics
NPI:1215484845
Name:LAN, GRACE SHIH-CHI (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:SHIH-CHI
Last Name:LAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 3051
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362-0031
Mailing Address - Country:US
Mailing Address - Phone:510-789-8820
Mailing Address - Fax:
Practice Address - Street 1:PSC 482 BOX 3051
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362-0031
Practice Address - Country:US
Practice Address - Phone:510-789-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35542122300000X, 1223S0112X
CADDS100394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist