Provider Demographics
NPI:1457519308
Name:CHAN, RICHARD WILKIN (DDS MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILKIN
Last Name:CHAN
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:19020 BOTHELL WAY NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2996
Mailing Address - Country:US
Mailing Address - Phone:425-485-9332
Mailing Address - Fax:425-486-0935
Practice Address - Street 1:19020 BOTHELL WAY NE
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2996
Practice Address - Country:US
Practice Address - Phone:425-485-9332
Practice Address - Fax:425-486-0935
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2015-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADE000112341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics