Provider Demographics
NPI:1518375781
Name:LIN, STANLEY WANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WANG
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTHPARK MEADOWS DENTAL GROUP AND ORTHODONTICS
Mailing Address - Street 2:401 WEST SLAUGHTER LANE #200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:512-291-8012
Mailing Address - Fax:
Practice Address - Street 1:SOUTHPARK MEADOWS DENTAL GROUP AND ORTHODONTICS
Practice Address - Street 2:401 WEST SLAUGHTER LANE #200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-291-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91016679921122300000X
TX34519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist