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Organization
THERESA C. FAN, DDS, PLLC
Active
Organization
THERESA C. FAN, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA C FAN DDS (OWNER/MEMBER)
(516) 382-4789
Entity
Organization
Contact information
Practice address
176 N VILLAGE AVE STE 1B, ROCKVILLE CENTRE, NY 11570-3800
(516) 382-4789
(516) 382-4789
Mailing address
120 HORTON HWY APT D6, MINEOLA, NY 11501-3929
(516) 578-7361
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
051937-1
NY
Other
Enumeration date
06/30/2018
Last updated
06/30/2018
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