Theresa C. Fan, DDS, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

051937-1 Issued in NY

Legal business name

THERESA C. FAN, DDS, PLLC

Practice address

176 N Village Ave Ste 1B
Rockville Centre, NY 11570-3800

Phone

(516) 382-4789

Fax

(516) 382-4789

NPI assigned

Jun 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa C Fan, DDS

Title

Owner/Member

Phone

(516) 382-4789

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530316800000",
    "number": "1205321304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HORTON HWY APT D6",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013929",
            "telephone_number": "516-578-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 N VILLAGE AVE STE 1B",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703800",
            "telephone_number": "516-382-4789",
            "fax_number": "516-382-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA C. FAN, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-30",
        "last_updated": "2018-06-30",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "516-382-4789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051937-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Rockville Centre, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.