Provider Demographics
NPI:1982596995
Name:ADRIAN S LINEBERGER IV DDS III LLC
Entity type:Organization
Organization Name:ADRIAN S LINEBERGER IV DDS III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-859-7550
Mailing Address - Street 1:347 N CASWELL RD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2530
Mailing Address - Country:US
Mailing Address - Phone:980-859-7550
Mailing Address - Fax:
Practice Address - Street 1:117 SPRATT ST STE A
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-4111
Practice Address - Country:US
Practice Address - Phone:803-548-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty