Provider Demographics
NPI:1316564495
Name:XU, QILIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:QILIN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2316
Mailing Address - Country:US
Mailing Address - Phone:267-368-0893
Mailing Address - Fax:
Practice Address - Street 1:543 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1225
Practice Address - Country:US
Practice Address - Phone:717-684-4666
Practice Address - Fax:717-684-2491
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427791223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty