Provider Demographics
NPI:1033269824
Name:CLARK, LYNN ROBINSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ROBINSON
Last Name:CLARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:WHITE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3310 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1310
Mailing Address - Country:US
Mailing Address - Phone:540-342-7221
Mailing Address - Fax:540-400-8304
Practice Address - Street 1:3310 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1310
Practice Address - Country:US
Practice Address - Phone:540-342-7221
Practice Address - Fax:540-400-8304
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401005811OtherDENTAL LICENSE NUMBER