Provider Demographics
NPI:1669718623
Name:BING WAN, DMD, PLLC
Entity type:Organization
Organization Name:BING WAN, DMD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BING
Authorized Official - Middle Name:CHIANG
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-659-2577
Mailing Address - Street 1:1513 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4629
Mailing Address - Country:US
Mailing Address - Phone:360-659-2577
Mailing Address - Fax:360-653-1700
Practice Address - Street 1:1513 10TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4629
Practice Address - Country:US
Practice Address - Phone:360-659-2577
Practice Address - Fax:360-653-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602904021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty