Provider Demographics
NPI:1427130996
Name:CHIN, STACY ALEXIS (DDS)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:ALEXIS
Last Name:CHIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S. 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-692-5533
Mailing Address - Fax:856-692-5565
Practice Address - Street 1:120 S 6TH ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4605
Practice Address - Country:US
Practice Address - Phone:856-692-5533
Practice Address - Fax:856-692-5565
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI023275001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry