Provider Demographics
NPI:1659063345
Name:BRIAN LIN DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:BRIAN LIN DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-919-0869
Mailing Address - Street 1:1122 E LINCOLN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1909
Mailing Address - Country:US
Mailing Address - Phone:714-921-2110
Mailing Address - Fax:714-974-0442
Practice Address - Street 1:1122 E LINCOLN AVE STE 207
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1909
Practice Address - Country:US
Practice Address - Phone:714-921-2110
Practice Address - Fax:714-974-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty