Provider Demographics
NPI:1679957245
Name:LIN, CAROL CHIA I (DDS)
Entity type:Individual
Prefix:
First Name:CAROL CHIA I
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 1:13314 E NORA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1360
Mailing Address - Country:US
Mailing Address - Phone:509-924-7600
Mailing Address - Fax:
Practice Address - Street 1:13314 E NORA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1360
Practice Address - Country:US
Practice Address - Phone:509-924-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60675630122300000X
WARR60564898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist