Individual
JEREMY CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
475 E BELL RD STE 150, PHOENIX, AZ 85022
(866) 831-5116
Mailing address
1221 E LE MARCHE AVE, PHOENIX, AZ 85022-3243
(602) 448-9443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10020
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/15/2017
Last updated
07/13/2018
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