Provider Demographics
NPI:1487988598
Name:WAN, STEVEN T K (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:T K
Last Name:WAN
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 1:2705 LIMITED LN NW STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6504
Mailing Address - Country:US
Mailing Address - Phone:360-241-7943
Mailing Address - Fax:
Practice Address - Street 1:2705 LIMITED LN NW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6504
Practice Address - Country:US
Practice Address - Phone:360-241-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist