Provider Demographics
NPI:1407026933
Name:STINE, LYNN THERESE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:THERESE
Last Name:STINE
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 1:609 GROUSELAND DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5142
Mailing Address - Country:US
Mailing Address - Phone:812-886-3958
Mailing Address - Fax:
Practice Address - Street 1:706 S 15TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4356
Practice Address - Country:US
Practice Address - Phone:812-882-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010706A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice