Provider Demographics
NPI:1700038163
Name:CONTEMPORARY FACIAL AND ORAL SURGERY PLLC
Entity Type:Organization
Organization Name:CONTEMPORARY FACIAL AND ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DDS
Authorized Official - Phone:214-572-8633
Mailing Address - Street 1:3443 E. RENNER RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:214-572-8633
Mailing Address - Fax:
Practice Address - Street 1:3443 E. RENNER RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:214-572-8633
Practice Address - Fax:214-572-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235333741OtherNPI
TX198110201Medicaid
TX192748502Medicaid
TX1700038163OtherGROUP NPI
TX1326241928OtherNPI
TX198109401Medicaid