MEDICARE: DR. WILLIAM B CHAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DEN01968	RI

General Provider Information

NPI Number	:	1194887661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM B CHAN D.M.D.

Provider Business Mailing Address
First Line	:	2359 MENDON RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-3707
Country	:	US
Telephone Number	:	401-334-3070
Fax Number	:	401-334-9031

Provider Business Practice Location Address
First Line	:	2359 MENDON RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-3707
Country	:	US
Telephone Number	:	401-334-3070
Fax Number	:	401-334-9031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

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Practice Location Address:

2359 MENDON RD
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02864-3707

Practice Phone: 401-334-3070
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1538593223 — DR. BENJAMIN MING FEI CHAN DMD, MS
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Practice Fax:

1013483981 — CHAN ORTHODONTIC DENTISTRY LLC
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1659424380 — MRS. JAIME STOREY KIESOW OTR/L
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