Provider Demographics
NPI:1467508390
Name:LINATOC, A JOHN (DMD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:JOHN
Last Name:LINATOC
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 KINGSTON HWY SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-8949
Mailing Address - Country:US
Mailing Address - Phone:706-295-9792
Mailing Address - Fax:706-295-9931
Practice Address - Street 1:1506 KINGSTON HWY SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-8949
Practice Address - Country:US
Practice Address - Phone:706-295-9792
Practice Address - Fax:706-295-9931
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0108061223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA109157OtherDORAL
GA39108OtherAVESIS
GA315105645AMedicaid
GA315105645AMedicaid