Provider Demographics
NPI:1114930450
Name:BACH, LYNDI LEVO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LYNDI
Middle Name:LEVO
Last Name:BACH
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:LYNDI
Other - Middle Name:LE
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:17575 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2302
Mailing Address - Country:US
Mailing Address - Phone:714-348-2684
Mailing Address - Fax:
Practice Address - Street 1:1920 E 17TH ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8626
Practice Address - Country:US
Practice Address - Phone:949-379-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics