# FAN OF DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fan Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619307105
- **Authorized official:** BENJAMIN FAN D.D.S. (OWNER)
- **Authorized official phone:** (214) 395-1217

## Contact information

- **Practice address:** 689 W RENNER RD, RICHARDSON, TX 75080-1345
- **Practice address phone:** (972) 234-5700
- **Mailing address:** 4517 TUSCANY DR, PLANO, TX 75093-7043
- **Mailing address phone:** (214) 395-1217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 25777 | TX | Yes |

## Other

- **Enumeration date:** 11/19/2013
- **Last updated:** 11/19/2013