Organization
DUCHESS DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK FAN DDS (OWNER)
(347) 688-9827
Entity
Organization
Contact information
Practice address
4301 W WILLIAM CANNON DR, SUITE B240, AUSTIN, TX 78749-1473
(512) 892-7800
(512) 892-7802
Mailing address
4301 W WILLIAM CANNON DR, SUITE B240, AUSTIN, TX 78749-1473
(512) 892-7800
(512) 892-7802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/09/2016
Last updated
11/09/2016
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