MEDICARE: DR. DERRICK LIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30894	TX

General Provider Information

NPI Number	:	1316327430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK LIN DDS

Provider Business Mailing Address
First Line	:	9903 GAZELLE FRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4326
Country	:	US
Telephone Number	:	361-894-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	9522 POTRANCO RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-9601
Country	:	US
Telephone Number	:	210-675-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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