Provider Demographics
NPI:1598973547
Name:LIN, XIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:XIA
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 1:7000 KENNEDY BLVD E
Mailing Address - Street 2:TOWER I-49C
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4818
Mailing Address - Country:US
Mailing Address - Phone:917-400-3611
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:BUILDING K-3
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9441
Practice Address - Country:US
Practice Address - Phone:973-335-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022609001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics