Provider Demographics
NPI:1740400456
Name:LIN, CARMELA IP (DMD)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:IP
Last Name:LIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CARMELA
Other - Middle Name:
Other - Last Name:IP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:403 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4527
Mailing Address - Country:US
Mailing Address - Phone:908-281-4317
Mailing Address - Fax:
Practice Address - Street 1:403 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4527
Practice Address - Country:US
Practice Address - Phone:908-281-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1014453011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice