Provider Demographics
NPI:1487974705
Name:CHAN, MAEMIE MING MING (DMD)
Entity type:Individual
Prefix:DR
First Name:MAEMIE
Middle Name:MING MING
Last Name:CHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W. 6TH
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-707-6135
Mailing Address - Fax:405-707-0602
Practice Address - Street 1:8101 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103
Practice Address - Country:US
Practice Address - Phone:216-229-7440
Practice Address - Fax:216-229-2501
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023179122300000X
OH30.023179122300000X
TX28193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist