Provider Demographics
NPI:1962514919
Name:CHIU, GORDON BEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:BEN
Last Name:CHIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 SW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3543
Mailing Address - Country:US
Mailing Address - Phone:305-598-1610
Mailing Address - Fax:305-247-0084
Practice Address - Street 1:925 NE 30TH TER STE 118
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-247-0099
Practice Address - Fax:305-247-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 141741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice