Provider Demographics
NPI:1679140990
Name:LIN, LEANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CENTRAL WAY UNIT 205
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6382
Mailing Address - Country:US
Mailing Address - Phone:413-884-2828
Mailing Address - Fax:
Practice Address - Street 1:17130 AVONDALE WAY NE STE 109
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4455
Practice Address - Country:US
Practice Address - Phone:425-883-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611983931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics