Provider Demographics
NPI:1245068790
Name:LIN, STEPHANIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:LIN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 DIEHL CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2664
Mailing Address - Country:US
Mailing Address - Phone:301-525-5400
Mailing Address - Fax:
Practice Address - Street 1:700 N FAIRFAX ST STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2090
Practice Address - Country:US
Practice Address - Phone:703-299-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD182441223G0001X
VA04014192371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice