Provider Demographics
NPI:1255530952
Name:CHINN, LISA E (DMD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:E
Last Name:CHINN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5423
Mailing Address - Country:US
Mailing Address - Phone:602-276-1029
Mailing Address - Fax:602-276-1838
Practice Address - Street 1:7006 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5423
Practice Address - Country:US
Practice Address - Phone:602-276-1029
Practice Address - Fax:602-276-1838
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry