Provider Demographics
NPI:1053465443
Name:PAN, ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRIDGE ST
Mailing Address - Street 2:CORLISS LANDING
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4362
Mailing Address - Country:US
Mailing Address - Phone:401-861-5600
Mailing Address - Fax:401-861-5603
Practice Address - Street 1:16 BRIDGE ST
Practice Address - Street 2:CORLISS LANDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4362
Practice Address - Country:US
Practice Address - Phone:401-861-5600
Practice Address - Fax:401-861-5603
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI029121223G0001X
MA210641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice