Provider Demographics
NPI:1811232747
Name:DR CHEAN DDS PA
Entity Type:Organization
Organization Name:DR CHEAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGCHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEAN IANLENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-953-3839
Mailing Address - Street 1:2700 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4530
Mailing Address - Country:US
Mailing Address - Phone:941-953-3839
Mailing Address - Fax:941-953-3811
Practice Address - Street 1:2700 S TAMIAMI TRL
Practice Address - Street 2:SUITE 10
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4530
Practice Address - Country:US
Practice Address - Phone:941-953-3839
Practice Address - Fax:941-953-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 11784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty