Provider Demographics
NPI:1992932172
Name:CHI, AMY THERESA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:THERESA
Last Name:CHI
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 1:3562 FILLMORE ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1312
Mailing Address - Country:US
Mailing Address - Phone:612-423-1129
Mailing Address - Fax:
Practice Address - Street 1:1829 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2566
Practice Address - Country:US
Practice Address - Phone:763-421-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist