Provider Demographics
NPI:1902853138
Name:CHIN, KENNETH ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALEXANDER
Last Name:CHIN
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 1:112 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-9739
Mailing Address - Country:US
Mailing Address - Phone:302-335-2642
Mailing Address - Fax:302-335-4600
Practice Address - Street 1:3019 MERRITT MILL RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1407
Practice Address - Country:US
Practice Address - Phone:410-219-3366
Practice Address - Fax:410-219-3680
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice