Provider Demographics
NPI:1144508292
Name:CHAN, JUSTIN NILE (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:NILE
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:6675 S CUSTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1838
Mailing Address - Country:US
Mailing Address - Phone:469-301-3212
Mailing Address - Fax:469-301-3213
Practice Address - Street 1:6675 S CUSTER RD STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1838
Practice Address - Country:US
Practice Address - Phone:469-301-3212
Practice Address - Fax:469-301-3213
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX279691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27280OtherMEDICAID - MCNA
TX2986143-06OtherMEDICAID - TMHP
TX1144508292OtherMEDICAID - DENTAQUEST