Provider Demographics
NPI:1598872681
Name:CHAN, TERENCE (DDS)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 S LINDEN RD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3437
Mailing Address - Country:US
Mailing Address - Phone:810-732-0640
Mailing Address - Fax:810-732-2264
Practice Address - Street 1:1122 S LINDEN RD
Practice Address - Street 2:BUILDING E
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3437
Practice Address - Country:US
Practice Address - Phone:810-732-0640
Practice Address - Fax:810-732-2264
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI172501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4863058Medicaid