Provider Demographics
NPI:1700049657
Name:PHAN, LOANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOANN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:C/O CHESTER COUNTY COMMMUNITY DENTAL CTR
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-0155
Mailing Address - Country:US
Mailing Address - Phone:610-383-3888
Mailing Address - Fax:610-383-4688
Practice Address - Street 1:744 E LINCOLN HWY
Practice Address - Street 2:STE 120
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320
Practice Address - Country:US
Practice Address - Phone:610-383-3888
Practice Address - Fax:610-383-4688
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030412/L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101938150001Medicaid