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General NPI Number Information
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NPI Number | 1669718623
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Entity Type | Organization
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Legal Business Name | BING WAN, DMD, PLLC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 1513 10TH ST
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City | MARYSVILLE
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State | WA
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Zip | 98270-4629
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Country | US
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Telephone | 360-659-2577
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Fax | 360-653-1700
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Provider Business Mailing Address
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Address Line | 1513 10TH ST
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City | MARYSVILLE
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State | WA
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Zip | 98270-4629
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Country | US
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Telephone | 360-659-2577
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Fax | 360-653-1700
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Authorized Official
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Title or Position | OWNER, ENDODONTIST
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Name | DR. BING CHIANG WAN
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Credential | DMD
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Telephone | 360-659-2577
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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 | DE60290402
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License Number State | WA
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