Provider Demographics
NPI:1619333853
Name:MARIAN T LIN DDS P S INC
Entity Type:Organization
Organization Name:MARIAN T LIN DDS P S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-271-7121
Mailing Address - Street 1:1620 DUVALL AVE NE
Mailing Address - Street 2:STE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3975
Mailing Address - Country:US
Mailing Address - Phone:425-271-7121
Mailing Address - Fax:425-271-7130
Practice Address - Street 1:1620 DUVALL AVE NE
Practice Address - Street 2:STE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-3975
Practice Address - Country:US
Practice Address - Phone:425-271-7121
Practice Address - Fax:425-271-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009812261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049036Medicaid