Provider Demographics
NPI:1295183051
Name:RICHARD CHAN ORTHODONTICS
Entity Type:Organization
Organization Name:RICHARD CHAN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILKIN
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:907-738-3204
Mailing Address - Street 1:638 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5613
Mailing Address - Country:US
Mailing Address - Phone:907-738-3204
Mailing Address - Fax:425-486-0935
Practice Address - Street 1:2220 DUNN ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9304
Practice Address - Country:US
Practice Address - Phone:907-738-3204
Practice Address - Fax:425-486-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1455261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental