Provider Demographics
NPI:1578764718
Name:CHAN, FLORA MANHAN (DDS)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:MANHAN
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 1:618TH DENTAL COMPANY
Mailing Address - Street 2:UNIT 15659, BOX 846
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:618TH DENTAL COMPANY
Practice Address - Street 2:UNIT 15659, BOX 846
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218
Practice Address - Country:US
Practice Address - Phone:0103-040-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice