Provider Demographics
NPI:1144420555
Name:CHIN, VANESSA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LEIGH
Last Name:CHIN
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 1:5017 BUBBLING CREEK LN
Mailing Address - Street 2:APT. 108
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-4467
Mailing Address - Country:US
Mailing Address - Phone:901-292-4856
Mailing Address - Fax:
Practice Address - Street 1:3645 GENTIAN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5687
Practice Address - Country:US
Practice Address - Phone:706-660-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics