Provider Demographics
NPI:1538430079
Name:CHIU, EVELYN H (D D S , PH D)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:H
Last Name:CHIU
Suffix:
Gender:F
Credentials:D D S , PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4612
Mailing Address - Country:US
Mailing Address - Phone:908-273-2254
Mailing Address - Fax:
Practice Address - Street 1:358 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4612
Practice Address - Country:US
Practice Address - Phone:908-273-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI170991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice