Provider Demographics
NPI:1821605940
Name:JADE W. GAN, DDS, PLLC
Entity Type:Organization
Organization Name:JADE W. GAN, DDS, PLLC
Other - Org Name:GENUINE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-802-7883
Mailing Address - Street 1:12902 BOTHELL EVERETT HWY STE E
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6635
Mailing Address - Country:US
Mailing Address - Phone:425-367-0303
Mailing Address - Fax:425-367-0313
Practice Address - Street 1:12902 BOTHELL EVERETT HWY STE E
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6635
Practice Address - Country:US
Practice Address - Phone:425-367-0303
Practice Address - Fax:425-367-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty