Basic Information
| Provider Information | |||||||||
| NPI: | 1487974705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | MAEMIE | ||||||||
| MiddleName: | MING MING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 W. 6TH | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057076135 | ||||||||
| FaxNumber: | 4057070602 | ||||||||
| Practice Location | |||||||||
| Address1: | 8101 EUCLID AVENUE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162297440 | ||||||||
| FaxNumber: | 2162292501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 30-023179 | OH | N | Dental Providers | Dentist | 122300000X | 30.023179 | OH | Y | Dental Providers | Dentist | 122300000X | 28193 | TX | N | Dental Providers | Dentist |
No ID Information.