Provider Demographics
NPI:1659457745
Name:CHAN, HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1728
Mailing Address - Country:US
Mailing Address - Phone:702-385-3688
Mailing Address - Fax:702-385-3866
Practice Address - Street 1:1212 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1728
Practice Address - Country:US
Practice Address - Phone:702-385-3688
Practice Address - Fax:702-385-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506424Medicaid