Provider Demographics
NPI:1215356456
Name:LIN, JENNY (DDS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LIN
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 1:1270 CRABB RIVER RD
Mailing Address - Street 2:STE.700
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5636
Mailing Address - Country:US
Mailing Address - Phone:281-937-1100
Mailing Address - Fax:281-937-1111
Practice Address - Street 1:1270 CRABB RIVER RD
Practice Address - Street 2:STE.700
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5636
Practice Address - Country:US
Practice Address - Phone:281-937-1100
Practice Address - Fax:281-937-1111
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice