Provider Demographics
NPI:1669049755
Name:FAN, JOIE (DDS)
Entity type:Individual
Prefix:
First Name:JOIE
Middle Name:
Last Name:FAN
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 1:1023 BUNGALOW PL
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4522
Mailing Address - Country:US
Mailing Address - Phone:626-231-6052
Mailing Address - Fax:
Practice Address - Street 1:5201 E ARROWHEAD PKWY
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-2715
Practice Address - Country:US
Practice Address - Phone:605-789-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist