Provider Demographics
NPI:1689891756
Name:CHAN, GEOFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
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 1:22725 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9532
Mailing Address - Country:US
Mailing Address - Phone:425-391-5511
Mailing Address - Fax:425-391-4923
Practice Address - Street 1:22725 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9532
Practice Address - Country:US
Practice Address - Phone:425-391-5511
Practice Address - Fax:425-391-4923
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE102411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice