Provider Demographics
NPI:1346554888
Name:WANG, LIN (DMD)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:35 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1512
Practice Address - Country:US
Practice Address - Phone:610-544-3630
Practice Address - Fax:610-544-7532
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice