Provider Demographics
NPI:1477267417
Name:CHAN DENTAL LLC
Entity type:Organization
Organization Name:CHAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-213-3021
Mailing Address - Street 1:7393 BROADVIEW RD STE G
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4445
Mailing Address - Country:US
Mailing Address - Phone:216-236-6300
Mailing Address - Fax:
Practice Address - Street 1:7393 BROADVIEW RD STE G
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-4445
Practice Address - Country:US
Practice Address - Phone:216-236-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental