Healthcare Provider Details

I. General information

NPI: 1124151592
Provider Name (Legal Business Name): JUDITH RENEE CHIN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 NE 26TH ST
WILTON MANORS FL
33305-1239
US

IV. Provider business mailing address

3300 S UNIVERSITY DR RM 4317
FT LAUDERDALE FL
33328-2004
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7663
  • Fax: 954-262-1782
Mailing address:
  • Phone: 954-262-7663
  • Fax: 954-262-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12009724
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number47207
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN24018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: