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General NPI Number Information
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NPI Number | 1851481980
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Entity Type | Individual
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Provider Name | LINC J CONN JR. DDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 600 MOYE BLVD ECU SCHOOL OF DENTAL MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-4300
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Country | US
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Telephone | 252-737-7024
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Fax | 252-737-7049
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Provider Business Mailing Address
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Address Line | 600 MOYE BLVD ECU SCHOOL OF DENTAL MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-4300
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Country | US
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Telephone | 252-737-7024
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Fax | 252-737-7049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15605
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9224
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License Number State | NC
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