Healthcare Provider Details

I. General information

NPI: 1073809117
Provider Name (Legal Business Name): LIN ZHU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 MOLALLA AVE
OREGON CITY OR
97045-4007
US

IV. Provider business mailing address

1200 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-4866
US

V. Phone/Fax

Practice location:
  • Phone: 503-650-2612
  • Fax:
Mailing address:
  • Phone: 310-622-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10373
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: