=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003345133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE M LINK DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2017
-----------------------------------------------------
Last Update Date | 06/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 580 KASE ST
-----------------------------------------------------
City | PLATTEVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53818-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-348-3031
-----------------------------------------------------
Fax | 608-348-9739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2512 WESTGATE DR UNIT 19
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31707-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1001527
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------