Individual
KENNETH FAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1110 WILFORD HALL LOOP, JBSA LACKLAND AFB, TX 78236
(210) 539-7866
Mailing address
1110 WILFORD HALL LOOP, JBSA LACKLAND AFB, TX 78236
Taxonomy
Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
Primary
DDS61109
CA
Other
Enumeration date
02/18/2010
Last updated
08/14/2023
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