Provider Demographics
NPI:1982048096
Name:GAN, JADE WAN-THENG (DDS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:WAN-THENG
Last Name:GAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2619
Mailing Address - Country:US
Mailing Address - Phone:425-640-5533
Mailing Address - Fax:425-640-5534
Practice Address - Street 1:23320 HWY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-789-3700
Practice Address - Fax:425-789-3750
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60500885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist