Individual
STEPHANIE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4820 W TAFT RD STE 214, LIVERPOOL, NY 13088-2807
(315) 413-1100
Mailing address
4820 W TAFT RD STE 214, LIVERPOOL, NY 13088-2807
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
060485
NY
Other
Enumeration date
08/14/2018
Last updated
08/11/2019
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