Provider Demographics
NPI:1306175492
Name:LIN, ZANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:ZANDER
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 W PARKER RD STE 199
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8131
Mailing Address - Country:US
Mailing Address - Phone:972-787-0892
Mailing Address - Fax:
Practice Address - Street 1:6009 W PARKER RD STE 199
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8131
Practice Address - Country:US
Practice Address - Phone:972-787-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590631223G0001X
TX278961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice