Provider Demographics
NPI:1104017839
Name:CHAN, BRIAN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:CHAN
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 1:6880 S. MCCARRAN BLVD STE. 9
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-825-8366
Mailing Address - Fax:775-825-8367
Practice Address - Street 1:6880 S. MCCARRAN BLVD STE. 9
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-825-8366
Practice Address - Fax:775-825-8367
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89531223G0001X
NV56421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice