MEDICARE: DR. VANESSA LEIGH CHIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN012999	GA

General Provider Information

NPI Number	:	1144420555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA LEIGH CHIN DDS

Provider Business Mailing Address
First Line	:	5017 BUBBLING CREEK LN
Second Line	:	APT. 108
City	:	MILLINGTON
State	:	TN
Zip	:	38053-4467
Country	:	US
Telephone Number	:	901-292-4856
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 GENTIAN BLVD
Second Line	:	SUITE 2
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5687
Country	:	US
Telephone Number	:	706-660-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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