Individual
MICHELLE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(864) 260-7285
Mailing address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(864) 260-7285
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7550
OK
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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