Priscilla O. Chan, DDS
Individual provider Active NPI Pediatric Dentistry · Buda, TX
NPI 1629570924 · NPPES record last updated Nov 17, 2023
Key facts
- NPI
- 1629570924
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 36009 (TX)
- Practice address
- 171 Carpenter Hill Drive
Buda, TX 78610 - Phone
- (732) 710-8304
- NPI assigned
- Mar 2, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 22DI02752800 | NJ | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| P. Chan, DDS PLLC | Pediatric Dentistry | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 36009 | TX | Yes |
| Pediatric Dentistry | 1223P0221X | 22DI02752800 | NJ |
Addresses
Primary practice location
171 Carpenter Hill Drive
Buda, TX 78610
Mailing address
302 Cypress Forest Dr
Kyle, TX 78640-2187
Phone (732) 710-8304
Other providers in Buda, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2023. 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.