Provider Demographics
NPI:1790198703
Name:LIN, LARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 JOY ST
Mailing Address - Street 2:APT# 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4051
Mailing Address - Country:US
Mailing Address - Phone:650-291-7777
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1077
Practice Address - Country:US
Practice Address - Phone:413-733-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18565681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice