Provider Demographics
NPI:1164073136
Name:LYNN H. DUBOFF, DMD, PLLC
Entity Type:Organization
Organization Name:LYNN H. DUBOFF, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:HARASTY
Authorized Official - Last Name:DUBOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-779-6137
Mailing Address - Street 1:237 HAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-8979
Mailing Address - Country:US
Mailing Address - Phone:802-855-8771
Mailing Address - Fax:
Practice Address - Street 1:72 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4568
Practice Address - Country:US
Practice Address - Phone:802-779-6137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1790969582OtherNPI