Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 08185 | IA |
NPI | 1144488966 |
---|---|
Provider Name | Andrew Wanley Chan |
First Address | Des Moines, IA 50312 |
Second Address | Des Moines, IA 50312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 24/08/2017 |