Provider Demographics
NPI:1134175714
Name:CHINN, ELLIOTT HAYDEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:HAYDEN
Last Name:CHINN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14607 SE 202ND AVE
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8718
Mailing Address - Country:US
Mailing Address - Phone:503-658-4020
Mailing Address - Fax:503-658-6251
Practice Address - Street 1:14607 SE 202ND AVE
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97015-8718
Practice Address - Country:US
Practice Address - Phone:503-658-4020
Practice Address - Fax:503-658-6251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR46061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133853Medicare ID - Type Unspecified