Provider Demographics
NPI:1235333741
Name:CHAN, STEPHEN M (DDS, MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 CROSS TIMBERS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1300
Mailing Address - Country:US
Mailing Address - Phone:972-436-1513
Mailing Address - Fax:
Practice Address - Street 1:651 CROSS TIMBERS RD STE 103
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1300
Practice Address - Country:US
Practice Address - Phone:972-436-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223701223S0112X, 204E00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery