Provider Demographics
NPI:1891759262
Name:PAN, ALAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:PAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6044
Mailing Address - Country:US
Mailing Address - Phone:916-781-6688
Mailing Address - Fax:916-781-8118
Practice Address - Street 1:1441 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6044
Practice Address - Country:US
Practice Address - Phone:916-781-6688
Practice Address - Fax:916-781-8118
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice