Provider Demographics
NPI:1972023307
Name:CHAN, ANGELA SUK-MAN (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUK-MAN
Last Name:CHAN
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 1:946 S WATSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3430
Mailing Address - Country:US
Mailing Address - Phone:734-436-1020
Mailing Address - Fax:
Practice Address - Street 1:946 S WATSON RD STE 101
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3430
Practice Address - Country:US
Practice Address - Phone:734-436-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist