Basic Information
| Provider Information | |||||||||
| NPI: | 1831186212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINHART | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | SHIPROCK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874200160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053686401 | ||||||||
| FaxNumber: | 5053686431 | ||||||||
| Practice Location | |||||||||
| Address1: | US HWY 160 & NAVAJO ROUTE 35 - RED MESA | ||||||||
| Address2: | |||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 5053686431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D5035476 | PA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 70981027 | 05 | CO | MEDICAID | 734956 | 05 | AZ | MEDICAID | 76438236 | 05 | NM | MEDICAID |