Provider Demographics
NPI:1780094060
Name:CHIN, ROBERT (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CHIN
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 1:1781 VILLAGE CENTER CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0573
Mailing Address - Country:US
Mailing Address - Phone:702-460-4068
Mailing Address - Fax:705-834-3332
Practice Address - Street 1:1781 VILLAGE CENTER CIR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0573
Practice Address - Country:US
Practice Address - Phone:702-460-4068
Practice Address - Fax:705-834-3332
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV70181223G0001X
390200000X
TX30843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist