Provider Demographics
NPI:1992928121
Name:CHAN, JOHN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 GEER RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2458
Mailing Address - Country:US
Mailing Address - Phone:209-667-2216
Mailing Address - Fax:209-667-1178
Practice Address - Street 1:2111 GEER RD
Practice Address - Street 2:SUITE 500
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2458
Practice Address - Country:US
Practice Address - Phone:209-667-2216
Practice Address - Fax:209-667-1178
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist