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Deactivated NPI 1356862908 Deactivated / Inactive NPI Male Practitioner

Dr. Jeff Phan , DMD

Dentist - Endodontics • Snohomish, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jeff Phan has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 05, 2017
NPI Deactivation Date July 08, 2019
Total Practice Duration ~2 Years of Practice (2017 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Jeff Phan, DMD was a registered Dentist - Endodontics practicing in Snohomish, WA. Throughout an active medical career spanning 2 years, Dr. Phan provided care at the practice location at 1001 AVENUE D STE 100 until profile deactivation on 2019-07-08.

Practice Location & Contact Primary Location

Practice Address

1001 Avenue D Ste 100

Snohomish, WA 982902081

Telephone 3605689694

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - Endodontics in Snohomish, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
1 Specialists

Practicing in Snohomish, WA (228 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-05-12
Dentist - Endodontics Primary Specialty

NUCC Taxonomy Code: 1223E0200X

State License WA 61262223

The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Dr. Cassidy Berday , DMD

Dentist - General Practice

NPI 1336959550

Doctor of Dental Medicine

Risha Khan

Dentist - General Practice

NPI 1518440072
Dr. Justin Flinkman , DDS

Dentist - General Practice

NPI 1578179339

Doctor of Dental Surgery

Dr. Aditi Vimawala , DDS

Dentist - General Practice

NPI 1629750211

Doctor of Dental Surgery

Dr. Sarah Choe , DDS

Dentist - General Practice

NPI 1811211287

Doctor of Dental Surgery

NPI 1821413253

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

18 Historical Events
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Medical Taxonomy / Specialty Registered (Primary Specialty) May 12, 2022

Dentist (License #61262223 in WA)

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Updated Practice Location May 07, 2022

Registered at 1001 AVENUE D STE 100, SNOHOMISH, WA 982902081 (Tel: 3605689694)

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Updated Business Mailing Address May 07, 2022

Registered at 1001 AVENUE D STE 100, SNOHOMISH, WA 982902081 (Tel: 3605689694)

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 07, 2022

Dentist (License #103220 in CA)

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Updated Practice Location July 01, 2021

Registered at 13625 RONALD W REAGAN BLVD STE 300, CEDAR PARK, TX 786132073 (Tel: 5128317429)

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Updated Business Mailing Address July 01, 2021

Registered at 13625 RONALD W REAGAN BLVD STE 300, CEDAR PARK, TX 786132073 (Tel: 5128317429)

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Provider Name / Credentials Updated July 01, 2021

Recorded as JEFF PHAN, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 01, 2021

Dentist (License #37211 in TX)

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NPI Profile Deactivated July 08, 2019

Record deactivated on July 08, 2019

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Updated Practice Location September 11, 2018

Registered at 2014 5TH AVE, OROVILLE, CA 959655815 (Tel: 5304035744)

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Updated Business Mailing Address September 11, 2018

Registered at 2014 5TH AVE, OROVILLE, CA 959655815 (Tel: 5304035744)

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 11, 2018

Dentist (License #103220 in CA)

NPI Profile Active July 05, 2017

NPI status registered as active in NPPES database

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Updated Practice Location July 05, 2017

Registered at 3350 LA JOLLA VILLAGE DR, SAN DIEGO, CA 921610002 (Tel: (858) 552-7525)

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Updated Business Mailing Address July 05, 2017

Registered at 3350 LA JOLLA VILLAGE DR, SAN DIEGO, CA 921610002 (Tel: 8585527525)

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Provider Name / Credentials Updated July 05, 2017

Recorded as JEFF PHAN, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 05, 2017

Student in an Organized Health Care Education/Training Program

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Initial NPI Registration & Enumeration July 05, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1356862908
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 05, 2017
Last Update: May 12, 2022
Deactivation Date: July 08, 2019
Sole Proprietor: No

Mailing Address

1001 Avenue D Ste 100

Snohomish, WA 982902081

Phone: 3605689694

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.