Provider Demographics
NPI:1851305742
Name:CHINN, CANDACE LAVRIE (DDS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LAVRIE
Last Name:CHINN
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 1:20615 BOTHELL EVERETT HWY
Mailing Address - Street 2:A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8556
Mailing Address - Country:US
Mailing Address - Phone:425-485-2942
Mailing Address - Fax:425-398-5933
Practice Address - Street 1:20615 BOTHELL EVERETT HWY
Practice Address - Street 2:A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-485-2942
Practice Address - Fax:425-398-5933
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist