Provider Demographics
NPI:1649356734
Name:CHAN, HENRY R (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:R
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5755 E KINGS CANYON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4744
Mailing Address - Country:US
Mailing Address - Phone:559-251-4281
Mailing Address - Fax:559-251-4282
Practice Address - Street 1:5755 E KINGS CANYON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4744
Practice Address - Country:US
Practice Address - Phone:559-251-4281
Practice Address - Fax:559-251-4282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice