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General NPI Number Information
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NPI Number | 1376618207
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC SPECIALISTS OF GREEN BAY, LTD
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1839 SCHEURING RD
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City | DE PERE
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State | WI
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Zip | 54115-9401
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Country | US
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Telephone | 920-336-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 1839 SCHEURING ROAD
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City | DE PERE
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State | WI
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Zip | 54115
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Country | US
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Telephone | 920-336-2299
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. EDWARD Y LIN
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Credential | DDS, MS
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Telephone | 920-336-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | WI
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