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Individual
DR. LINC J CONN JR.
Active
Individual
DR. LINC J CONN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MPH
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
15605
TX
1223G0001X
General Practice Dentistry
Primary
9224
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090674501
—
TX
01
—
090674502
MEDICAID
TX
01
—
83Y605
BLUE CROSS BLUE SHIELD
—
01
—
87116
UNITED CONCORDIA
—
Enumeration date
10/12/2006
Last updated
02/14/2012
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