JACK FAN DDS NPI 1831455955

NPI Information

  • NPI: 1831455955
  • Provider Name: JACK FAN, DDS
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • Address: 4301 W WILLIAM CANNON DR
    BLDG B, SUITE 240
    AUSTIN, TX
    ZIP 78749
  • Phone: (512) 892-7800

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NPI Details

Jack Fan, DDS is a general practice dentist in Austin, TX. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. Jack Fan, DDS NPI is 1831455955. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4301 W WILLIAM CANNON DR
BLDG B, SUITE 240
AUSTIN, TX
ZIP 78749-473
Phone: (512) 892-7800
Fax: (512) 892-7805

The enumeration date for this NPI number is 4/3/2012 and was last updated on 11/9/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice28806TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1TX 28806OTHERTEXASTX LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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