Provider Demographics
NPI:1225409469
Name:BRENT C. LIN, DDS INC
Entity Type:Organization
Organization Name:BRENT C. LIN, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-577-8779
Mailing Address - Street 1:3040 E 9TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2938
Mailing Address - Country:US
Mailing Address - Phone:925-577-8779
Mailing Address - Fax:
Practice Address - Street 1:3040 E 9TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2938
Practice Address - Country:US
Practice Address - Phone:925-577-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty