Provider Demographics
NPI:1992925309
Name:CHAN, SANDRA GAYE (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GAYE
Last Name:CHAN
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 1:10624 S. EASTERN AVE.
Mailing Address - Street 2:STE N
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-407-6700
Mailing Address - Fax:702-407-6710
Practice Address - Street 1:10624 S. EASTERN AVE.
Practice Address - Street 2:STE N
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-407-6700
Practice Address - Fax:702-407-6710
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33251223G0001X
CA352321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice