Provider Demographics
NPI:1396030938
Name:LIN, EMILY (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:LIN
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 1:1090 NORTHCHASE PKWY SE STE 290
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6402
Mailing Address - Country:US
Mailing Address - Phone:678-904-5665
Mailing Address - Fax:
Practice Address - Street 1:4173 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2221
Practice Address - Country:US
Practice Address - Phone:443-743-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice