Provider Demographics
NPI:1225001829
Name:ZHAN, PHILLIP H (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:H
Last Name:ZHAN
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 1:4927 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1552
Mailing Address - Country:US
Mailing Address - Phone:612-729-6150
Mailing Address - Fax:612-722-8817
Practice Address - Street 1:4927 34TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1552
Practice Address - Country:US
Practice Address - Phone:612-729-6150
Practice Address - Fax:612-722-8817
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN280495600OtherMEDICAL ASSISTANCE NUMBER