Provider Demographics
NPI:1144488966
Name:CHAN, ANDREW WANLEY (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WANLEY
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GRAND AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312
Mailing Address - Country:US
Mailing Address - Phone:515-246-1933
Mailing Address - Fax:515-246-8156
Practice Address - Street 1:2600 GRAND AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312
Practice Address - Country:US
Practice Address - Phone:515-246-1933
Practice Address - Fax:515-246-8156
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics