Provider Demographics
NPI:1962492181
Name:CHIN, GRACE ENCARNACION (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ENCARNACION
Last Name:CHIN
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:259 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2204
Mailing Address - Country:US
Mailing Address - Phone:718-619-1529
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER- PEDIATRIC DENTISTRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:347-577-4950
Practice Address - Fax:347-577-4926
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2020-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT89401223P0221X
NJ22DI022677011223P0221X
NJ22DI022677001223P0221X
PADS0381151223P0221X
NY0496501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry