Provider Demographics
NPI:1730477738
Name:VERIN, LINDA AYANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:AYANA
Last Name:VERIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:AYANA
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1333 CAMINO DEL RIO S
Mailing Address - Street 2:#202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3520
Mailing Address - Country:US
Mailing Address - Phone:909-556-0869
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S
Practice Address - Street 2:#202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:909-556-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105071223G0001X
CA64133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice