Provider Demographics
NPI:1891006128
Name:LIN, WINSTON (DDS)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 COBBLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4309
Mailing Address - Country:US
Mailing Address - Phone:310-612-2284
Mailing Address - Fax:
Practice Address - Street 1:9640 BRUCEVILLE RD
Practice Address - Street 2:101
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5936
Practice Address - Country:US
Practice Address - Phone:916-686-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry