Provider Demographics
NPI:1821149428
Name:LIN, JODY C (DMD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:C
Last Name:LIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 VALLEY BRUSH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10925 S EASTERN AVE
Practice Address - Street 2:#130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4949
Practice Address - Country:US
Practice Address - Phone:702-222-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist