Provider Demographics
NPI:1699728592
Name:CHIN, CHRISTINE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CHIN
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 1:1600 SW CEDAR HILLS BLVD
Mailing Address - Street 2:ST. 107
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5439
Mailing Address - Country:US
Mailing Address - Phone:503-643-7502
Mailing Address - Fax:503-641-4771
Practice Address - Street 1:1600 SW CEDAR HILLS BLVD
Practice Address - Street 2:ST. 107
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5439
Practice Address - Country:US
Practice Address - Phone:503-643-7502
Practice Address - Fax:503-641-4771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR66311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice