Provider Demographics
NPI:1851481980
Name:CONN, LINC J JR (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:LINC
Middle Name:J
Last Name:CONN
Suffix:JR
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MOYE BLVD
Mailing Address - Street 2:ECU SCHOOL OF DENTAL MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4300
Mailing Address - Country:US
Mailing Address - Phone:252-737-7024
Mailing Address - Fax:252-737-7049
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU SCHOOL OF DENTAL MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-737-7024
Practice Address - Fax:252-737-7049
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15605122300000X
NC92241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090674501Medicaid
83Y605OtherBLUE CROSS BLUE SHIELD
TX090674502OtherMEDICAID
87116OtherUNITED CONCORDIA
TX090674502OtherMEDICAID
TX090674501Medicaid