Provider Demographics
NPI:1447628516
Name:CHAN, ASHLEY (DDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PIERCE ST APT 1109
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1048
Mailing Address - Country:US
Mailing Address - Phone:707-344-1173
Mailing Address - Fax:
Practice Address - Street 1:545 PIERCE ST APT 1109
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1048
Practice Address - Country:US
Practice Address - Phone:707-344-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist