Provider Demographics
NPI:1053469155
Name:LINCOLN, JOSEPH G (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:LINCOLN
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 1:363 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-3036
Mailing Address - Country:US
Mailing Address - Phone:847-487-5462
Mailing Address - Fax:
Practice Address - Street 1:363 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-3036
Practice Address - Country:US
Practice Address - Phone:847-487-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice