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Contact Information

JACK Z FAN, DMD
FORT EISENHOWER DENTAC
BLDG 38717
APO, AA30905
 Phone: 801-647-5392
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for JACK Z FAN · (Male)

NPI Number 1730070863
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 07/15/2025
Last updated 08/14/2025 - About 10 months ago
Sole proprietor 1 No
Identifiers
  • UT License # 14224225-9926
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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