Healthcare Provider Details

I. General information

NPI: 1326207291
Provider Name (Legal Business Name): EDWARD ALLEN CHANEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262
US

IV. Provider business mailing address

PO BOX 378904
CHICAGO IL
60637-8904
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax:
Mailing address:
  • Phone: 312-550-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.017873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: