Provider Demographics
NPI:1689930869
Name:CHAN, GAR N (DDS)
Entity Type:Individual
Prefix:
First Name:GAR
Middle Name:N
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 1:7880 WREN AVE STE E154
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7802
Mailing Address - Country:US
Mailing Address - Phone:408-847-1234
Mailing Address - Fax:408-842-7494
Practice Address - Street 1:7880 WREN AVE STE E154
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7802
Practice Address - Country:US
Practice Address - Phone:408-847-1234
Practice Address - Fax:408-842-7494
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist