Healthcare Provider Details

I. General information

NPI: 1073736989
Provider Name (Legal Business Name): JESSICA A LINN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FAIRLAWN AVE W
WINSTED MN
55395
US

IV. Provider business mailing address

PO BOX 728
WINSTED MN
55395
US

V. Phone/Fax

Practice location:
  • Phone: 320-485-3881
  • Fax:
Mailing address:
  • Phone: 320-485-3881
  • Fax: 320-485-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11591
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: