Provider Demographics
NPI:1538209325
Name:LIN, HSUAN-LI (DDS)
Entity type:Individual
Prefix:
First Name:HSUAN-LI
Middle Name:
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 1:983 BELLEFLOWER PL
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2328
Mailing Address - Country:US
Mailing Address - Phone:614-578-7721
Mailing Address - Fax:
Practice Address - Street 1:3646 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-231-8102
Practice Address - Fax:614-231-4801
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672004Medicaid
OH9184909OtherDORAL PROVIDER #
OH260135218033OtherCARE SOURCE PROVIDER #