Provider Demographics
NPI:1508363870
Name:LIN, CALVIN TAO (DMD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:TAO
Last Name:LIN
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 1:230 N KESWICK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4804
Mailing Address - Country:US
Mailing Address - Phone:215-885-4252
Mailing Address - Fax:215-885-7487
Practice Address - Street 1:230 N KESWICK AVE # B
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4804
Practice Address - Country:US
Practice Address - Phone:215-885-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0418101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS041810OtherPA STATE LICENSE