Provider Demographics
NPI:1174731657
Name:CHIN, LEO P (DMD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:P
Last Name:CHIN
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:5020 GUNN HWY
Mailing Address - Street 2:#200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6379
Mailing Address - Country:US
Mailing Address - Phone:813-264-7006
Mailing Address - Fax:813-264-6072
Practice Address - Street 1:5020 GUNN HWY
Practice Address - Street 2:#200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6379
Practice Address - Country:US
Practice Address - Phone:813-264-7006
Practice Address - Fax:813-264-6072
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL115751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics