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General NPI Number Information
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NPI Number | 1255439691
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Entity Type | Organization
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Legal Business Name | ANDREW W CHAN DDS PC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2600 GRAND AVENUE SUITE 400
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City | DES MOINES
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State | IA
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Zip | 50312
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Country | US
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Telephone | 515-246-1933
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Fax | 515-246-8156
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Provider Business Mailing Address
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Address Line | 2600 GRAND AVENUE SUITE 400
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City | DES MOINES
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State | IA
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Zip | 50312
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Country | US
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Telephone | 515-246-1933
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Fax | 515-246-8156
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW WANLEY CHAN
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Credential | D.D.S.
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Telephone | 515-246-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 08185
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License Number State | IA
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