Provider Demographics
NPI:1467557561
Name:CHAN, GERALD W (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
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 1:8 GRANITE PLACE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-977-7777
Mailing Address - Fax:301-948-1271
Practice Address - Street 1:19650 CLUB HOUSE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3039
Practice Address - Country:US
Practice Address - Phone:301-977-7777
Practice Address - Fax:301-948-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice