Provider Demographics
NPI:1588748750
Name:LIN, THERESA (DDS)
Entity type:Individual
Prefix:DR
First Name:THERESA
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 1:11 EAGLE PT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3317
Mailing Address - Country:US
Mailing Address - Phone:949-701-0108
Mailing Address - Fax:
Practice Address - Street 1:219 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2802
Practice Address - Country:US
Practice Address - Phone:714-667-0161
Practice Address - Fax:714-667-0161
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice