Provider Demographics
NPI:1104486521
Name:CHIAO, CHRISTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:CHIAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 MASSACHUSETTS AVE UNIT 404
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4079
Mailing Address - Country:US
Mailing Address - Phone:978-394-3397
Mailing Address - Fax:
Practice Address - Street 1:691 MASSACHUSETTS AVE UNIT 404
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4079
Practice Address - Country:US
Practice Address - Phone:978-394-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584411223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry