Provider Demographics
NPI:1235651795
Name:LYNOTT, MONICA MORIE (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MORIE
Last Name:LYNOTT
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 1:200 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7644
Mailing Address - Country:US
Mailing Address - Phone:469-733-4391
Mailing Address - Fax:817-702-2140
Practice Address - Street 1:3301 STALCUP RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1726
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-920-0729
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33036122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33036OtherSTATE BOARD OF DENTAL EXAMINERS