Provider Demographics
NPI:1942640743
Name:K CHAN DENTAL, P.C.
Entity Type:Organization
Organization Name:K CHAN DENTAL, P.C.
Other - Org Name:NORTH SHORE ARTISTIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-501-2882
Mailing Address - Street 1:310 HAPP RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3455
Mailing Address - Country:US
Mailing Address - Phone:847-501-2882
Mailing Address - Fax:847-501-2883
Practice Address - Street 1:310 HAPP RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3455
Practice Address - Country:US
Practice Address - Phone:847-501-2882
Practice Address - Fax:847-501-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276621223G0001X
IL0190169081223G0001X
IL0190280011223G0001X
IL020007283124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty