Provider Demographics
NPI:1578731386
Name:LIN, JEFFREY (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1008 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1126
Mailing Address - Country:US
Mailing Address - Phone:570-307-8100
Mailing Address - Fax:570-307-8101
Practice Address - Street 1:1008 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1126
Practice Address - Country:US
Practice Address - Phone:570-307-8100
Practice Address - Fax:570-307-8101
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0369701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery