Dr. Micah Chan, D.M.D., M.S.
Dentist, Periodontics in Richfield, MN. Individual provider (NPI-1).
NPI number1083083323
StatusActive
Last updated in NPPESSep 16, 2015
Details
- NPI
- 1083083323
- Entity type
- Individual (NPI-1)
- Name
- Dr. Micah Chan
- Credential
- D.M.D., M.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 16, 2015
- Last updated
- Sep 16, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | S99 | MN | Yes |
Practice location
6601 Lyndale Ave SRichfield, MN 55423-2477
Phone 612-243-9357
Mailing address
8301 Stanley RdApt #114
Bloomington, MN 55437-1282
Phone 612-910-6203
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