Provider Demographics
NPI:1043650849
Name:BOSCO P. CHAN, D.D.S.
Entity Type:Organization
Organization Name:BOSCO P. CHAN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOSCO
Authorized Official - Middle Name:PUI-KI
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-278-6077
Mailing Address - Street 1:323 W CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2805
Mailing Address - Country:US
Mailing Address - Phone:517-278-6077
Mailing Address - Fax:517-278-7045
Practice Address - Street 1:323 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2805
Practice Address - Country:US
Practice Address - Phone:517-278-6077
Practice Address - Fax:517-278-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010100551223G0001X
MI29010209081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty