Provider Demographics
NPI:1437452109
Name:NATHANIEL CHAN DMD PC
Entity Type:Organization
Organization Name:NATHANIEL CHAN DMD PC
Other - Org Name:ADVANCED DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-545-5102
Mailing Address - Street 1:353 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1933
Mailing Address - Country:US
Mailing Address - Phone:781-545-5102
Mailing Address - Fax:
Practice Address - Street 1:56 NEW DRIFTWAY
Practice Address - Street 2:ADVANCED DENTAL ARTS
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4533
Practice Address - Country:US
Practice Address - Phone:781-545-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATHANIEL CHAN DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-17
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty