MEDICARE: DR. RUSSELL SOY 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	1223G0001X	General Practice Dentistry	1763	RI

General Provider Information

NPI Number	:	1417910696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL SOY CHIN DDS

Provider Business Mailing Address
First Line	:	1288 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-1851
Country	:	US
Telephone Number	:	401-728-1450
Fax Number	:	401-727-1488

Provider Business Practice Location Address
First Line	:	1288 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-1851
Country	:	US
Telephone Number	:	401-728-1450
Fax Number	:	401-727-1488

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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