Provider Demographics
NPI:1073736989
Name:LINN, JESSICA A (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:LINN
Suffix:
Gender:F
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395
Mailing Address - Country:US
Mailing Address - Phone:320-485-3881
Mailing Address - Fax:320-485-4322
Practice Address - Street 1:123 FAIRLAWN AVE W
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395
Practice Address - Country:US
Practice Address - Phone:320-485-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist