Provider Demographics
NPI:1104039510
Name:LYNN E GASSOWAY,DDS,INC
Entity Type:Organization
Organization Name:LYNN E GASSOWAY,DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:GASSOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-938-2875
Mailing Address - Street 1:8412 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1419
Mailing Address - Country:US
Mailing Address - Phone:219-938-2875
Mailing Address - Fax:219-938-2875
Practice Address - Street 1:8412 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-1419
Practice Address - Country:US
Practice Address - Phone:219-938-2875
Practice Address - Fax:219-938-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007149261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental