Provider Demographics
NPI:1790855989
Name:LIN, DIANA YUAN (DDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:YUAN
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:Y
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9272 S FAIRMONT CIR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3581
Mailing Address - Country:US
Mailing Address - Phone:901-309-5112
Mailing Address - Fax:
Practice Address - Street 1:624 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2540
Practice Address - Country:US
Practice Address - Phone:901-853-2520
Practice Address - Fax:901-854-9273
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000077051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice