Provider Demographics
NPI:1134658354
Name:CHANEY, ANDREW B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:CHANEY
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 1:9000 CHAPEL RD APT 33102
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8935
Mailing Address - Country:US
Mailing Address - Phone:210-883-7117
Mailing Address - Fax:
Practice Address - Street 1:121 EASTGATE PLZ
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2868
Practice Address - Country:US
Practice Address - Phone:210-883-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist