Provider Demographics
NPI:1942498746
Name:BENJAMIN J. LIN, D.M.D., INC.
Entity Type:Organization
Organization Name:BENJAMIN J. LIN, D.M.D., INC.
Other - Org Name:CUSTOM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-387-6577
Mailing Address - Street 1:3409 CALLOWAY DR UNIT 402
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2517
Mailing Address - Country:US
Mailing Address - Phone:661-387-6577
Mailing Address - Fax:
Practice Address - Street 1:3409 CALLOWAY DR UNIT 402
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2517
Practice Address - Country:US
Practice Address - Phone:661-387-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-07
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty