Provider Demographics
NPI:1720525470
Name:NATHANIEL CHAN DMD PC
Entity Type:Organization
Organization Name:NATHANIEL CHAN DMD PC
Other - Org Name:ADVANCED DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-545-5102
Mailing Address - Street 1:353 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-987-1357
Mailing Address - Fax:617-471-8161
Practice Address - Street 1:353 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-987-1357
Practice Address - Fax:617-471-8161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATHANIEL CHAN DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty