Provider Demographics
NPI:1043376551
Name:LIN, ALEXANDER CY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:CY
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SEVENTH ST, SUITE B
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2079
Mailing Address - Country:US
Mailing Address - Phone:503-656-8799
Mailing Address - Fax:503-655-0971
Practice Address - Street 1:1515 SEVENTH ST SUITE B
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-656-8799
Practice Address - Fax:503-655-0971
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-72391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082776Medicaid
OR7239OtherDENTAL LICENSE NO.