Provider Demographics
NPI:1801346580
Name:GAN DENTAL PLLC
Entity type:Organization
Organization Name:GAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YU
Authorized Official - Middle Name:
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-460-7656
Mailing Address - Street 1:2323 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-7141
Mailing Address - Country:US
Mailing Address - Phone:409-777-4777
Mailing Address - Fax:
Practice Address - Street 1:2323 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590
Practice Address - Country:US
Practice Address - Phone:702-460-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307911223G0001X
TX309111223P0221X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty