Provider Demographics
NPI:1316175227
Name:QIU, LIN (DMD)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:QIU
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 1:2010 W CHESTER PIKE
Mailing Address - Street 2:STE 420
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2700
Mailing Address - Country:US
Mailing Address - Phone:610-449-8511
Mailing Address - Fax:610-449-8639
Practice Address - Street 1:2010 W CHESTER PK
Practice Address - Street 2:SUITE 420
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-449-8511
Practice Address - Fax:610-449-8639
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030995L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice