Provider Demographics
NPI:1174671358
Name:OSTLUND, LYNN ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ROBERT
Last Name:OSTLUND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-3840
Mailing Address - Country:US
Mailing Address - Phone:651-776-1084
Mailing Address - Fax:
Practice Address - Street 1:1043 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-3840
Practice Address - Country:US
Practice Address - Phone:651-776-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice