Provider Demographics
NPI:1023107539
Name:LIN, STACY (DDS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13322 HIGHWAY 99
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5440
Mailing Address - Country:US
Mailing Address - Phone:425-743-3911
Mailing Address - Fax:425-742-7014
Practice Address - Street 1:13322 HIGHWAY 99
Practice Address - Street 2:SUITE 202
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5440
Practice Address - Country:US
Practice Address - Phone:425-743-3911
Practice Address - Fax:425-742-7014
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice