Provider Demographics
NPI:1821257007
Name:PHAN, CATHERINE DANG-CHAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:DANG-CHAU
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 GRAND AVE SUITE 7 A
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1821
Mailing Address - Country:US
Mailing Address - Phone:847-336-5586
Mailing Address - Fax:847-336-5589
Practice Address - Street 1:4949 GRAND AVE SUITE 7 A
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1821
Practice Address - Country:US
Practice Address - Phone:847-336-5586
Practice Address - Fax:847-336-5589
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist