Provider Demographics
NPI:1619265618
Name:LINN, COLLIN TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:TAYLOR
Last Name:LINN
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 1:278 GRANDVIEW PL
Mailing Address - Street 2:
Mailing Address - City:TROUT RUN
Mailing Address - State:PA
Mailing Address - Zip Code:17771-9259
Mailing Address - Country:US
Mailing Address - Phone:570-506-4130
Mailing Address - Fax:
Practice Address - Street 1:2039 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1206
Practice Address - Country:US
Practice Address - Phone:570-323-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist