Doctor Name: | CHASE WICKER |
NPI Number: | 1114301231 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 30444 |
Business Practice Address: | 341 Dental Science Bldg W Iowa City, IA - 522421001 |
Business Phone Number: | 3193357469 |
Business Fax Number: | |
Mailing Address: | 322 Dental Science Bldg S, IOWA CITY |
State: | IA |
Postal Code: | 522421001 |
Phone Number: | 3193357440 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2015 |
NPI Last Update Date: | 07/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 30444 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |