Provider Demographics
NPI:1881638799
Name:DWAN, ANDREW RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:DWAN
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:PO BOX 847
Mailing Address - Street 2:206 S MAIN ST
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-4090
Mailing Address - Fax:989-846-4160
Practice Address - Street 1:206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-4090
Practice Address - Fax:989-846-4160
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice