Provider Demographics
NPI:1578817961
Name:DOUGLAS LIN, DDS, INC
Entity Type:Organization
Organization Name:DOUGLAS LIN, DDS, INC
Other - Org Name:HERCULES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-741-1777
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-741-1777
Mailing Address - Fax:
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-741-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty