Provider Demographics
NPI:1154476901
Name:LEYDE, LYNN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
Last Name:LEYDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-1523
Mailing Address - Country:US
Mailing Address - Phone:206-542-7967
Mailing Address - Fax:
Practice Address - Street 1:721 N 182ND ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4400
Practice Address - Country:US
Practice Address - Phone:206-542-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist