Provider Demographics
NPI:1811011653
Name:WAYNE S CHANLER, DMD, PC
Entity Type:Organization
Organization Name:WAYNE S CHANLER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:585-374-6323
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-0308
Mailing Address - Country:US
Mailing Address - Phone:585-374-6323
Mailing Address - Fax:585-374-6324
Practice Address - Street 1:106 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512
Practice Address - Country:US
Practice Address - Phone:585-374-6323
Practice Address - Fax:585-374-6324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0321211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5828183OtherAETNA
NY032121OtherLICENSE
NY00464291Medicaid
NY32121OtherCSEA
NY7710OtherEXCELLUS BLUE CROSS
NY7710OtherEXCELLUS BLUE CROSS