Provider Demographics
NPI:1124397054
Name:LOLLINI, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LOLLINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 PINEWOOD CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4789
Mailing Address - Country:US
Mailing Address - Phone:925-413-8827
Mailing Address - Fax:
Practice Address - Street 1:1920 PINEWOOD CMNS
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550
Practice Address - Country:US
Practice Address - Phone:925-413-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist