Provider Demographics
NPI:1568504272
Name:CHAN, CYNTHIA M (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1534
Mailing Address - Country:US
Mailing Address - Phone:916-591-2148
Mailing Address - Fax:
Practice Address - Street 1:3131 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1534
Practice Address - Country:US
Practice Address - Phone:402-441-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60171223P0221X
TX262091223P0221X, 1223P0221X
CODEN.000074881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry