Provider Demographics
NPI:1003905233
Name:RUSSELL S. CHIN, DDS, LTS
Entity Type:Organization
Organization Name:RUSSELL S. CHIN, DDS, LTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-728-1450
Mailing Address - Street 1:1288 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1851
Mailing Address - Country:US
Mailing Address - Phone:401-728-1450
Mailing Address - Fax:401-727-1488
Practice Address - Street 1:1288 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1851
Practice Address - Country:US
Practice Address - Phone:401-728-1450
Practice Address - Fax:401-727-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI17631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1763OtherDELTA DENTAL
RI8175-5OtherBLUE CROSS BLUE SHIELD RI
MARG0025OtherBLUE CROSS BLUE SHIELD MA
MARG0025OtherBLUE CROSS BLUE SHIELD MA