Provider Demographics
NPI:1497049696
Name:LIN, MELISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISA
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 1:1800 116TH AVE NE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3043
Mailing Address - Country:US
Mailing Address - Phone:425-802-2978
Mailing Address - Fax:
Practice Address - Street 1:1800 116TH AVE NE
Practice Address - Street 2:SUITE #105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3043
Practice Address - Country:US
Practice Address - Phone:425-454-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601716001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice