Provider Demographics
NPI:1124152715
Name:CHANLER, WAYNE S (DMD,PC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:S
Last Name:CHANLER
Suffix:
Gender:M
Credentials:DMD,PC
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 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 N. 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0321211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00464291Medicaid
NY32121OtherCSEA
NY7710OtherBLUE CROSS
NY5828183OtherAETNA