Provider Demographics
NPI:1538140629
Name:CHAN, STEVEN DANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANA
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:DANA
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1737
Mailing Address - Country:US
Mailing Address - Phone:510-791-0971
Mailing Address - Fax:510-791-1042
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-791-0971
Practice Address - Fax:510-791-1042
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry