Charlene Renee Chan, D.D.S., M.S.D.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Sebastopol, CA
NPI 1043349111 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043349111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 036066 (CA)
- Practice address
- 6800 Palm Ave
Suite B
Sebastopol, CA 95472-4269 - Phone
- (707) 823-1200
- Fax
- (707) 823-5363
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036066 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 036066 | CA | Yes |
Addresses
Primary practice location
6800 Palm Ave
Suite B
Sebastopol, CA 95472-4269
Mailing address
6800 Palm Ave
Suite B
Sebastopol, CA 95472-4269
Other providers in Sebastopol, CA
- Mary Ann Carpenter
- Miranda Natalia Carpenter
- Anne Casey-Nielson
- Emilce Castro Deller
- Sara Champie
- Valerie Chan
- Margaret B Chandler
- Charles N Harris PHD a Psychological Corp
- Geetinder Kaur Chattha
- Katharine Chalmers Chelton
All providers in Sebastopol, CA · Orthodontics and Dentofacial Orthopedics Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.