Provider Demographics
NPI:1962737338
Name:LIN, EDWARD Y (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:Y
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 S. WEBSTER AVE.
Mailing Address - Street 2:ORTHODONTIC SPECIALISTS OF GREEN BAY
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-336-2299
Mailing Address - Fax:920-336-2847
Practice Address - Street 1:2821 S. WEBSTER AVE.
Practice Address - Street 2:ORTHODONTIC SPECIALISTS OF GREEN BAY
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-336-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51500151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics