Provider Demographics
NPI:1154658581
Name:LIN, LAUREL KATHLEEN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:KATHLEEN
Last Name:LIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BOYLSTON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3304
Mailing Address - Country:US
Mailing Address - Phone:617-262-1422
Mailing Address - Fax:
Practice Address - Street 1:359 BOYLSTON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3304
Practice Address - Country:US
Practice Address - Phone:617-262-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH87056124Q00000X
GADH009897124Q00000X
AZ5274124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist