Provider Demographics
NPI:1518068444
Name:CHU, GRACE TAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:TAN
Last Name:CHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 BELT LINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9126
Mailing Address - Country:US
Mailing Address - Phone:972-385-8559
Mailing Address - Fax:972-385-7415
Practice Address - Street 1:6009 BELT LINE RD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9126
Practice Address - Country:US
Practice Address - Phone:972-385-8559
Practice Address - Fax:972-385-7415
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics