Provider Demographics
NPI:1912161126
Name:LIN, LISA S (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
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 1:41 EAST 57TH ST
Mailing Address - Street 2:SUITE 2501
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-421-6055
Mailing Address - Fax:212-751-6614
Practice Address - Street 1:41 EAST 57TH ST
Practice Address - Street 2:SUITE 2501
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-421-6055
Practice Address - Fax:212-751-6614
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist