Provider Demographics
NPI:1720229719
Name:LIN, SHERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERMAN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 EL CAMINO REAL STE J28
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1048
Mailing Address - Country:US
Mailing Address - Phone:858-259-2225
Mailing Address - Fax:
Practice Address - Street 1:12925 EL CAMINO REAL STE J28
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1048
Practice Address - Country:US
Practice Address - Phone:858-259-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist